Provider Demographics
NPI:1922627124
Name:LAVENDER, DENA DUNN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:DUNN
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2001
Mailing Address - Country:US
Mailing Address - Phone:717-216-3239
Mailing Address - Fax:
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-216-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN519765L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA171717Medicaid