Provider Demographics
NPI:1215019054
Name:DENNIS, MAVERLY VIOLA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MAVERLY
Middle Name:VIOLA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAVERLY
Other - Middle Name:VIOLA
Other - Last Name:MULLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10 UNION SQ 2ND FL
Mailing Address - Street 2:PHILLIPS AMBULATORY CARE CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-420-2000
Mailing Address - Fax:
Practice Address - Street 1:10 UNION SQ 2ND FL
Practice Address - Street 2:PHILLIPS AMBULATORY CARE CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner