Provider Demographics
NPI:1235968827
Name:MERVEILLE, ANNE CYNTHIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:CYNTHIA
Last Name:MERVEILLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3146
Mailing Address - Country:US
Mailing Address - Phone:646-409-7039
Mailing Address - Fax:
Practice Address - Street 1:95 PINE ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3146
Practice Address - Country:US
Practice Address - Phone:646-409-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330354164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse