Provider Demographics
NPI:1265159867
Name:CHALLENGER, LAVINIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:
Last Name:CHALLENGER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAVI
Other - Middle Name:
Other - Last Name:CHALLENGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:11838 SIERRA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2141
Mailing Address - Country:US
Mailing Address - Phone:916-712-4036
Mailing Address - Fax:
Practice Address - Street 1:11838 SIERRA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2141
Practice Address - Country:US
Practice Address - Phone:916-712-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016513261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care