Provider Demographics
NPI:1073203170
Name:WARD, LAVENDER YVETTE
Entity Type:Individual
Prefix:
First Name:LAVENDER
Middle Name:YVETTE
Last Name:WARD
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 1:405 33RD ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-1706
Mailing Address - Country:US
Mailing Address - Phone:304-859-0535
Mailing Address - Fax:
Practice Address - Street 1:405 33RD ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-1706
Practice Address - Country:US
Practice Address - Phone:304-859-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant