Provider Demographics
NPI:1073101861
Name:STONE, LAVEDA JOANNE
Entity Type:Individual
Prefix:
First Name:LAVEDA
Middle Name:JOANNE
Last Name:STONE
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 1:1452 N KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-1711
Mailing Address - Country:US
Mailing Address - Phone:316-208-4941
Mailing Address - Fax:
Practice Address - Street 1:1452 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-1711
Practice Address - Country:US
Practice Address - Phone:316-208-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS361KYN347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle