Provider Demographics
NPI:1467882464
Name:LAVERGNE, NILKA MARIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:NILKA
Middle Name:MARIA
Last Name:LAVERGNE
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 1:75 N HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-2349
Mailing Address - Country:US
Mailing Address - Phone:386-931-7546
Mailing Address - Fax:
Practice Address - Street 1:75 N HARRIS DR
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-2349
Practice Address - Country:US
Practice Address - Phone:386-931-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3410372163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse