Provider Demographics
NPI:1053879429
Name:PREVAL, NOVA LA MARR (CRNP)
Entity type:Individual
Prefix:
First Name:NOVA
Middle Name:LA MARR
Last Name:PREVAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2908 CABIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1839
Mailing Address - Country:US
Mailing Address - Phone:301-257-0563
Mailing Address - Fax:414-800-1839
Practice Address - Street 1:2908 CABIN CREEK DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1839
Practice Address - Country:US
Practice Address - Phone:301-257-0563
Practice Address - Fax:414-800-1839
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR213039363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health