Provider Demographics
NPI:1285373076
Name:MOHORN, MARVETT
Entity type:Individual
Prefix:
First Name:MARVETT
Middle Name:
Last Name:MOHORN
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:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33302-0620
Mailing Address - Country:US
Mailing Address - Phone:954-751-8529
Mailing Address - Fax:
Practice Address - Street 1:865 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7033
Practice Address - Country:US
Practice Address - Phone:954-529-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty