Provider Demographics
NPI:1568997385
Name:DESRAVINES, MARIE ELNIDE
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:ELNIDE
Last Name:DESRAVINES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:ELNIDE
Other - Last Name:DESRAVINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:144 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2618
Mailing Address - Country:US
Mailing Address - Phone:305-205-6554
Mailing Address - Fax:
Practice Address - Street 1:144 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-2618
Practice Address - Country:US
Practice Address - Phone:305-205-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9407834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse