Provider Demographics
NPI:1376867358
Name:LAVENDER, BILLINDA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:BILLINDA
Middle Name:NICOLE
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BRANFORD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1140
Mailing Address - Country:US
Mailing Address - Phone:937-339-4092
Mailing Address - Fax:
Practice Address - Street 1:718 BRANFORD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1140
Practice Address - Country:US
Practice Address - Phone:937-339-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse