Provider Demographics
NPI:1710007067
Name:CAVENY, LISETTE (CM-A)
Entity Type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:
Last Name:CAVENY
Suffix:
Gender:F
Credentials:CM-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-7231
Mailing Address - Country:US
Mailing Address - Phone:918-798-0555
Mailing Address - Fax:918-485-3554
Practice Address - Street 1:109 S HARRILL AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-5317
Practice Address - Country:US
Practice Address - Phone:918-485-3554
Practice Address - Fax:918-485-8371
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program