Provider Demographics
NPI:1316373509
Name:DESLANDES, LAVONDA HUNISE (CNA)
Entity Type:Individual
Prefix:
First Name:LAVONDA
Middle Name:HUNISE
Last Name:DESLANDES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 W MELVINA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2339
Mailing Address - Country:US
Mailing Address - Phone:414-736-1275
Mailing Address - Fax:
Practice Address - Street 1:4642 W MELVINA ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2339
Practice Address - Country:US
Practice Address - Phone:414-736-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174837374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide