Provider Demographics
NPI:1801364419
Name:BATSON, MARVALLISON
Entity type:Individual
Prefix:
First Name:MARVALLISON
Middle Name:
Last Name:BATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 OCEAN AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3827
Mailing Address - Country:US
Mailing Address - Phone:718-812-1752
Mailing Address - Fax:
Practice Address - Street 1:625 OCEAN AVE APT 5H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3827
Practice Address - Country:US
Practice Address - Phone:718-812-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide