Provider Demographics
NPI:1467702704
Name:THIRUVALLUVAN, NAGAVALLI (MSN, APN, NP-C, CRRN)
Entity Type:Individual
Prefix:MRS
First Name:NAGAVALLI
Middle Name:
Last Name:THIRUVALLUVAN
Suffix:
Gender:F
Credentials:MSN, APN, NP-C, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PAVLOCAK CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4426
Mailing Address - Country:US
Mailing Address - Phone:732-318-6005
Mailing Address - Fax:551-278-0675
Practice Address - Street 1:11 PAVLOCAK CT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-4426
Practice Address - Country:US
Practice Address - Phone:732-318-6005
Practice Address - Fax:973-994-7786
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00399200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health