Provider Demographics
NPI:1962977827
Name:GALVAN, MARIA IDA (LVN)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:IDA
Last Name:GALVAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 CHASE RIDGE TRL APT 1119
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7530
Mailing Address - Country:US
Mailing Address - Phone:361-765-2772
Mailing Address - Fax:
Practice Address - Street 1:6950 CHASE RIDGE TRL APT 1119
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7530
Practice Address - Country:US
Practice Address - Phone:361-765-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194609164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse