Provider Demographics
NPI:1437705209
Name:GJOVIK, LARAYNE LAMAE (LPN)
Entity Type:Individual
Prefix:
First Name:LARAYNE
Middle Name:LAMAE
Last Name:GJOVIK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34534 STATE HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-8208
Mailing Address - Country:US
Mailing Address - Phone:218-242-9579
Mailing Address - Fax:
Practice Address - Street 1:34534 STATE HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-8208
Practice Address - Country:US
Practice Address - Phone:218-242-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant