Provider Demographics
NPI:1922245596
Name:LAVELLE, LAN AI (NP)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:AI
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 KILMARNOCK WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6077
Mailing Address - Country:US
Mailing Address - Phone:951-776-1960
Mailing Address - Fax:951-776-1960
Practice Address - Street 1:822 KILMARNOCK WAY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6077
Practice Address - Country:US
Practice Address - Phone:951-776-1960
Practice Address - Fax:951-776-1960
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily