Provider Demographics
NPI:1457900987
Name:WHITE, LAVONIA D
Entity Type:Individual
Prefix:MS
First Name:LAVONIA
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COLOMBO AVE APT 6102
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5311
Mailing Address - Country:US
Mailing Address - Phone:602-318-5953
Mailing Address - Fax:
Practice Address - Street 1:1201 COLOMBO AVE APT 6102
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5311
Practice Address - Country:US
Practice Address - Phone:602-318-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider