Provider Demographics
NPI:1003684713
Name:HAIGHT, LAVONNA (STNA)
Entity Type:Individual
Prefix:
First Name:LAVONNA
Middle Name:
Last Name:HAIGHT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GILEAD ST LOT 10
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9574
Mailing Address - Country:US
Mailing Address - Phone:614-312-9469
Mailing Address - Fax:
Practice Address - Street 1:229 GILEAD ST LOT 10
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9574
Practice Address - Country:US
Practice Address - Phone:614-312-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker