Provider Demographics
NPI:1376259234
Name:ELEAM, LAVELL
Entity Type:Individual
Prefix:
First Name:LAVELL
Middle Name:
Last Name:ELEAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 FORT MIRO AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2984
Mailing Address - Country:US
Mailing Address - Phone:318-680-8122
Mailing Address - Fax:
Practice Address - Street 1:2315 FORT MIRO AVE APT 4A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2984
Practice Address - Country:US
Practice Address - Phone:318-680-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)