Provider Demographics
NPI:1790194017
Name:LAVENIA, CHRISTIAN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:LAVENIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7764 ARMISTEAD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1919
Mailing Address - Country:US
Mailing Address - Phone:703-339-3806
Mailing Address - Fax:703-372-1993
Practice Address - Street 1:8109 HINSON FARM RD
Practice Address - Street 2:SUITE 504
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3415
Practice Address - Country:US
Practice Address - Phone:703-780-2800
Practice Address - Fax:703-780-0461
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171809363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health