Provider Demographics
NPI:1841596889
Name:DUFFY, ALFREDA SHAVONE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ALFREDA
Middle Name:SHAVONE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ERNESTINE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5976
Mailing Address - Country:US
Mailing Address - Phone:678-668-9293
Mailing Address - Fax:
Practice Address - Street 1:217 ERNESTINE WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5976
Practice Address - Country:US
Practice Address - Phone:678-668-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse