Provider Demographics
NPI:1558804203
Name:MARVIN, NANCY D (MSN, RN, NP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:MARVIN
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MOREHEAD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:704-362-5391
Mailing Address - Fax:
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:BLDG 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-348-2992
Practice Address - Fax:704-971-0035
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCW217AMedicare PIN