Provider Demographics
NPI:1073145736
Name:LAFAVE, ALEXIS (LPN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LAFAVE
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:NY
Mailing Address - Zip Code:13435
Mailing Address - Country:US
Mailing Address - Phone:315-737-3439
Mailing Address - Fax:
Practice Address - Street 1:6054 CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403
Practice Address - Country:US
Practice Address - Phone:315-737-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336888-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse