Provider Demographics
NPI:1992278899
Name:PURVIS, MARILYN MARIE
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERRY
Other - Middle Name:
Other - Last Name:HEARTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1963 JOHNS MAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9774
Mailing Address - Country:US
Mailing Address - Phone:601-826-1573
Mailing Address - Fax:
Practice Address - Street 1:1963 JOHNS MAYTON RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-9774
Practice Address - Country:US
Practice Address - Phone:601-826-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care