Provider Demographics
NPI:1043073315
Name:BENEMON, LAVETTA
Entity Type:Individual
Prefix:
First Name:LAVETTA
Middle Name:
Last Name:BENEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14243 ELRINGTON HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4702
Mailing Address - Country:US
Mailing Address - Phone:202-656-6802
Mailing Address - Fax:
Practice Address - Street 1:14243 ELRINGTON HOLLOW TRL
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-4702
Practice Address - Country:US
Practice Address - Phone:202-656-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide