Provider Demographics
NPI:1740096122
Name:SARAVIA, NATHALIE JASMIN (BSN, RN)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:JASMIN
Last Name:SARAVIA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3418
Mailing Address - Country:US
Mailing Address - Phone:631-220-2496
Mailing Address - Fax:
Practice Address - Street 1:153 MERRILL ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3418
Practice Address - Country:US
Practice Address - Phone:631-220-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824422-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse