Provider Demographics
NPI:1558507160
Name:CRIMES, LAVERA L (RN)
Entity Type:Individual
Prefix:MS
First Name:LAVERA
Middle Name:L
Last Name:CRIMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 BENNETT VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2201
Mailing Address - Country:US
Mailing Address - Phone:716-465-8529
Mailing Address - Fax:
Practice Address - Street 1:61 BENNETT VILLAGE TER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2201
Practice Address - Country:US
Practice Address - Phone:716-465-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4280471163W00000X, 163WG0000X, 163WH0200X, 163WM1400X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support