Provider Demographics
NPI:1134311707
Name:LAVIN, JEAN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:LAVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHALMERS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-1217
Mailing Address - Country:US
Mailing Address - Phone:914-594-3131
Mailing Address - Fax:914-594-4513
Practice Address - Street 1:12 CHALMERS BLVD
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1217
Practice Address - Country:US
Practice Address - Phone:914-594-3131
Practice Address - Fax:914-594-4513
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501189-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics