Provider Demographics
NPI:1518247030
Name:MERVIL, MAGDALINE (RN, NP)
Entity Type:Individual
Prefix:
First Name:MAGDALINE
Middle Name:
Last Name:MERVIL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-2731
Mailing Address - Country:US
Mailing Address - Phone:631-949-6286
Mailing Address - Fax:631-281-3080
Practice Address - Street 1:292 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-2731
Practice Address - Country:US
Practice Address - Phone:631-949-6286
Practice Address - Fax:631-281-3080
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556485163W00000X
NY33 336962363LF0000X
NYF336962-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily