Provider Demographics
NPI:1669018230
Name:ANDERSON, MARVEL M
Entity Type:Individual
Prefix:MS
First Name:MARVEL
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARVEL
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2264 SAUVAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4741
Mailing Address - Country:US
Mailing Address - Phone:772-453-8456
Mailing Address - Fax:
Practice Address - Street 1:2264 SAUVAGE AVE
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4741
Practice Address - Country:US
Practice Address - Phone:772-453-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker