Provider Demographics
NPI:1174012306
Name:MAVARO, CHRISTINE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:MAVARO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:98 CLAYPIT RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1903
Mailing Address - Country:US
Mailing Address - Phone:718-966-5920
Mailing Address - Fax:646-754-9747
Practice Address - Street 1:160 E 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-263-9936
Practice Address - Fax:646-754-9747
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner