Provider Demographics
NPI:1295027886
Name:HAZAIMH, LAVONDA PROPST (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAVONDA
Middle Name:PROPST
Last Name:HAZAIMH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 HEATHER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4511
Mailing Address - Country:US
Mailing Address - Phone:336-785-1685
Mailing Address - Fax:
Practice Address - Street 1:3851 HEATHER VIEW LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4511
Practice Address - Country:US
Practice Address - Phone:336-785-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16400000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse