Provider Demographics
NPI:1942659354
Name:MCLAVERTY, MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MCLAVERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 CASTELLO RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5606
Mailing Address - Country:US
Mailing Address - Phone:856-305-9981
Mailing Address - Fax:
Practice Address - Street 1:379 CASTELLO RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5606
Practice Address - Country:US
Practice Address - Phone:856-305-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA851886261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center