Provider Demographics
NPI:1417689894
Name:INGRAMBUTLER, LAVORIS ANTONITTA
Entity Type:Individual
Prefix:MS
First Name:LAVORIS
Middle Name:ANTONITTA
Last Name:INGRAMBUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 CHAUNCEY PL APT 301
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1028
Mailing Address - Country:US
Mailing Address - Phone:202-607-7187
Mailing Address - Fax:
Practice Address - Street 1:4701 BENNING RD SE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5102
Practice Address - Country:US
Practice Address - Phone:202-580-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant