Provider Demographics
NPI:1629305453
Name:GAVIRIA, MARLY (RN)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:
Last Name:GAVIRIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3734
Mailing Address - Country:US
Mailing Address - Phone:610-739-8820
Mailing Address - Fax:
Practice Address - Street 1:101 S 17TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6704
Practice Address - Country:US
Practice Address - Phone:610-739-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN589495163W00000X
NJ26NR13445700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse