Provider Demographics
NPI:1245530328
Name:NYAIDHO, LA VERNE JEAN
Entity type:Individual
Prefix:
First Name:LA VERNE
Middle Name:JEAN
Last Name:NYAIDHO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 ANGIE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3869
Mailing Address - Country:US
Mailing Address - Phone:972-639-4202
Mailing Address - Fax:
Practice Address - Street 1:947 ANGIE LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3869
Practice Address - Country:US
Practice Address - Phone:972-639-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services