Provider Demographics
NPI:1235302621
Name:TAYLOR, LAVENNA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LAVENNA
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAVENNA
Other - Middle Name:JEAN
Other - Last Name:BRANGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:VAPSHCS AMERICAN LAKE
Mailing Address - Street 2:BLDG 7
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1772
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERAN DRIVE
Practice Address - Street 2:BLDG 7
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-589-4166
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00082032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse