Provider Demographics
NPI:1184628687
Name:LAVIN, ROBERTA PROFFITT (APRN, BC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:PROFFITT
Last Name:LAVIN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S EADS ST
Mailing Address - Street 2:APT 1411
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4725
Mailing Address - Country:US
Mailing Address - Phone:202-205-4782
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4611
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000084459163W00000X
TNAPN0000006454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily