Provider Demographics
NPI:1942778980
Name:JOSEPH, MARVA L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:L
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MARVA
Other - Middle Name:LAVETTER
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11404 ARNOLD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2039
Mailing Address - Country:US
Mailing Address - Phone:313-283-8512
Mailing Address - Fax:313-535-2614
Practice Address - Street 1:33742 W 12 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3358
Practice Address - Country:US
Practice Address - Phone:248-893-6610
Practice Address - Fax:248-893-6746
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704238507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily