Provider Demographics
NPI:1700509361
Name:JEAN-LOUIS, MARIE NIRVA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:NIRVA
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 LULLWATER MAIN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5708
Mailing Address - Country:US
Mailing Address - Phone:770-873-7854
Mailing Address - Fax:
Practice Address - Street 1:3940 LULLWATER MAIN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5708
Practice Address - Country:US
Practice Address - Phone:770-873-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF11180665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily