Provider Demographics
NPI:1710168208
Name:GALVAN, MARIE YVETTE (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:YVETTE
Last Name:GALVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 GRAPEVINE HWY
Mailing Address - Street 2:314
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2805
Mailing Address - Country:US
Mailing Address - Phone:817-683-5117
Mailing Address - Fax:
Practice Address - Street 1:729 GRAPEVINE HWY
Practice Address - Street 2:314
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2805
Practice Address - Country:US
Practice Address - Phone:817-683-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant