Provider Demographics
NPI:1649510579
Name:AVENA, ELIZABETH MARIE (LVN)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:AVENA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E COLORADO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6617
Mailing Address - Country:US
Mailing Address - Phone:626-577-2261
Mailing Address - Fax:626-204-0159
Practice Address - Street 1:2555 E COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6617
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:626-204-0159
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266569164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse