Provider Demographics
NPI:1821540410
Name:VILLARD, LAWANDA M
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:M
Last Name:VILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 ALGONQUIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2994
Mailing Address - Country:US
Mailing Address - Phone:248-636-9154
Mailing Address - Fax:
Practice Address - Street 1:1016 ALGONQUIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2994
Practice Address - Country:US
Practice Address - Phone:248-636-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care