Provider Demographics
NPI:1699393520
Name:MIRVILLE, YVES F
Entity Type:Individual
Prefix:
First Name:YVES
Middle Name:F
Last Name:MIRVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5091
Mailing Address - Country:US
Mailing Address - Phone:212-363-0075
Mailing Address - Fax:
Practice Address - Street 1:48 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5091
Practice Address - Country:US
Practice Address - Phone:212-363-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292544-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse