Provider Demographics
NPI:1528461571
Name:GYAN, MAVIS (RN)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:GYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CONCOURSE VLG W APT 5F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3811
Mailing Address - Country:US
Mailing Address - Phone:718-690-0961
Mailing Address - Fax:
Practice Address - Street 1:780 CONCOURSE VLG W APT 5F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3811
Practice Address - Country:US
Practice Address - Phone:718-690-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse