Provider Demographics
NPI:1255485744
Name:CAVALIER, MARY L (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:CAVALIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21032 STRATHMOOR LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7334
Mailing Address - Country:US
Mailing Address - Phone:714-968-6378
Mailing Address - Fax:
Practice Address - Street 1:8041 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7034
Practice Address - Country:US
Practice Address - Phone:714-842-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 0159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily