Provider Demographics
NPI:1659653582
Name:LAVOGUE, BARBARA (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LAVOGUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 W CLIFTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3308
Mailing Address - Country:US
Mailing Address - Phone:860-559-2485
Mailing Address - Fax:440-934-6147
Practice Address - Street 1:1439 W CLIFTON BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3308
Practice Address - Country:US
Practice Address - Phone:860-559-2485
Practice Address - Fax:440-934-6147
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12573NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058385Medicaid
OHH036360OtherMEDICARE-(P-TAN)