Provider Demographics
NPI:1053719492
Name:PREVAL, MARIE CARDINE (NP-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CARDINE
Last Name:PREVAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 THE WOODS DR APT 2033
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3867
Mailing Address - Country:US
Mailing Address - Phone:407-590-0089
Mailing Address - Fax:
Practice Address - Street 1:4400 THE WOODS DR APT 2033
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-3867
Practice Address - Country:US
Practice Address - Phone:407-590-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001849363L00000X
FL9275392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner