Provider Demographics
NPI:1043776230
Name:SLAVEN, JANICE (LPN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:SLAVEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2706
Mailing Address - Country:US
Mailing Address - Phone:360-575-7084
Mailing Address - Fax:360-575-7088
Practice Address - Street 1:1324 30TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2706
Practice Address - Country:US
Practice Address - Phone:360-575-7084
Practice Address - Fax:360-575-7088
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00049579164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse