Provider Demographics
NPI:1083484901
Name:LAVIN, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LAVIN
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 1:325 HAY ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5590
Mailing Address - Country:US
Mailing Address - Phone:941-799-9354
Mailing Address - Fax:
Practice Address - Street 1:517 NC 210 N
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2709
Practice Address - Country:US
Practice Address - Phone:910-436-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant