Provider Demographics
NPI:1477617421
Name:LAVIN, ELEANOR P (APRN,BC,CNS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:P
Last Name:LAVIN
Suffix:
Gender:F
Credentials:APRN,BC,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-2726
Mailing Address - Country:US
Mailing Address - Phone:406-234-7890
Mailing Address - Fax:406-234-7890
Practice Address - Street 1:2000 CLARK ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2726
Practice Address - Country:US
Practice Address - Phone:406-234-7890
Practice Address - Fax:406-234-7890
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12752363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000439212Medicaid
MT0000439212Medicaid