Provider Demographics
NPI:1689849879
Name:AVAKIAN, LANY SIVONGSAY (NP)
Entity Type:Individual
Prefix:
First Name:LANY
Middle Name:SIVONGSAY
Last Name:AVAKIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LANY
Other - Middle Name:
Other - Last Name:SIVONGSAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6121 N THESTA ST
Mailing Address - Street 2:#204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-438-7390
Mailing Address - Fax:559-438-7166
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:#204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-438-7390
Practice Address - Fax:559-438-7166
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689849879Medicaid
CA1689849879Medicaid
CAAY181YMedicare PIN