Provider Demographics
NPI:1124404439
Name:POPE-ANDERSON, LAVENIA MARIA
Entity Type:Individual
Prefix:
First Name:LAVENIA
Middle Name:MARIA
Last Name:POPE-ANDERSON
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 1:339 CHURCH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3838
Mailing Address - Country:US
Mailing Address - Phone:669-666-2202
Mailing Address - Fax:
Practice Address - Street 1:339 CHURCH AVE APT 3
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3838
Practice Address - Country:US
Practice Address - Phone:669-666-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN186945164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse