Provider Demographics
NPI:1891530986
Name:RAVIX, MARIE RENELLE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:RENELLE
Last Name:RAVIX
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 1:313 TALMADGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2507
Mailing Address - Country:US
Mailing Address - Phone:413-507-9914
Mailing Address - Fax:
Practice Address - Street 1:313 TALMADGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2507
Practice Address - Country:US
Practice Address - Phone:413-507-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2362368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse