Provider Demographics
NPI:1821556481
Name:WILLIS-CRITTENTON, LAVETTE
Entity Type:Individual
Prefix:MRS
First Name:LAVETTE
Middle Name:
Last Name:WILLIS-CRITTENTON
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 1:11 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2818
Mailing Address - Country:US
Mailing Address - Phone:267-225-0017
Mailing Address - Fax:
Practice Address - Street 1:11 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2818
Practice Address - Country:US
Practice Address - Phone:267-225-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA-PUC-6420940343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)