Provider Demographics
NPI:1992330922
Name:NORVILLE, LANA VICTORIA (RN, CDE)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:VICTORIA
Last Name:NORVILLE
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD S
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6806
Mailing Address - Country:US
Mailing Address - Phone:347-853-3276
Mailing Address - Fax:
Practice Address - Street 1:4234 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2668
Practice Address - Country:US
Practice Address - Phone:347-341-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612244163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator