Provider Demographics
NPI:1407339740
Name:DORVIL, MARIELLE
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:DORVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 NW 118TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2328
Mailing Address - Country:US
Mailing Address - Phone:786-991-7829
Mailing Address - Fax:
Practice Address - Street 1:789 NW 118TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2328
Practice Address - Country:US
Practice Address - Phone:786-991-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5158395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse