Provider Demographics
NPI:1306426028
Name:LEYVA, MARVIN (RN)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:LEYVA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2845
Mailing Address - Country:US
Mailing Address - Phone:856-405-4332
Mailing Address - Fax:856-794-5712
Practice Address - Street 1:524 N WEST BLVD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2845
Practice Address - Country:US
Practice Address - Phone:856-405-4332
Practice Address - Fax:856-794-5712
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19611500163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology