Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mavern Wallace

Individual provider Registered Nurse · NPI 1902166614

Mavern Wallace is a Registered Nurse in Valley Stream, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2012

Practice location Address checks out

13 Cleveland St
Valley Stream, NY 11580-6003
Phone: (516) 823-0739
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 584436 (NY)

Record details

NPI number1902166614
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 29, 2012
Last updated in NPPESMay 29, 2012
Mailing address103 E Carpenter St, Valley Stream, NY 11580-4419

Other providers in Valley Stream