Provider Demographics
NPI:1750059259
Name:REID, LAVERNE (LVN)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 WILCREST DR APT 2418
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2192
Mailing Address - Country:US
Mailing Address - Phone:183-298-3748
Mailing Address - Fax:
Practice Address - Street 1:9520 WILCREST DR APT 2418
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2192
Practice Address - Country:US
Practice Address - Phone:832-983-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222216164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse