Provider Demographics
NPI:1508265752
Name:PRICE, LAVELLA HAWKINS
Entity Type:Individual
Prefix:MS
First Name:LAVELLA
Middle Name:HAWKINS
Last Name:PRICE
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 1:23 PARKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4009
Mailing Address - Country:US
Mailing Address - Phone:716-901-5672
Mailing Address - Fax:
Practice Address - Street 1:23 PARKVIEW TER
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4009
Practice Address - Country:US
Practice Address - Phone:716-901-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482173-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse