Provider Demographics
NPI:1205065331
Name:FITTS, LAVONNE ALINE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:LAVONNE
Middle Name:ALINE
Last Name:FITTS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 TIMBERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-9350
Mailing Address - Country:US
Mailing Address - Phone:724-473-0321
Mailing Address - Fax:
Practice Address - Street 1:604 TIMBERBROOK CT
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-9350
Practice Address - Country:US
Practice Address - Phone:724-473-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN237499L163W00000X
CO70251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse