Provider Demographics
NPI:1841740123
Name:WELLS, LAVONA (LVN)
Entity Type:Individual
Prefix:
First Name:LAVONA
Middle Name:
Last Name:WELLS
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 1:578 FIGUEROA DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5276
Mailing Address - Country:US
Mailing Address - Phone:626-696-3243
Mailing Address - Fax:
Practice Address - Street 1:578 FIGUEROA DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5276
Practice Address - Country:US
Practice Address - Phone:626-696-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127043164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse