Provider Demographics
NPI:1669868915
Name:NEWKIRT, LAVATTE (LPN)
Entity type:Individual
Prefix:
First Name:LAVATTE
Middle Name:
Last Name:NEWKIRT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14580 GREENFIELD RD
Mailing Address - Street 2:APT 147
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-4110
Mailing Address - Country:US
Mailing Address - Phone:313-392-3747
Mailing Address - Fax:
Practice Address - Street 1:14580 GREENFIELD RD
Practice Address - Street 2:APT 147
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-4110
Practice Address - Country:US
Practice Address - Phone:313-392-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703092620251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care