Provider Demographics
NPI:1306222419
Name:WEBSTER-DOWELL, LAVERN
Entity Type:Individual
Prefix:
First Name:LAVERN
Middle Name:
Last Name:WEBSTER-DOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAVERN
Other - Middle Name:
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 BAYMEADOWS CIR E APT 504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7686
Mailing Address - Country:US
Mailing Address - Phone:904-562-8664
Mailing Address - Fax:
Practice Address - Street 1:1255 LILA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3550
Practice Address - Country:US
Practice Address - Phone:904-383-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3300612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015427400Medicaid
FLIH381ZMedicare PIN