Provider Demographics
NPI:1801391685
Name:HARRIS, LAVETTE ANIQUEA
Entity type:Individual
Prefix:MS
First Name:LAVETTE
Middle Name:ANIQUEA
Last Name:HARRIS
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 1:704 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2713
Mailing Address - Country:US
Mailing Address - Phone:405-473-7401
Mailing Address - Fax:
Practice Address - Street 1:704 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-2713
Practice Address - Country:US
Practice Address - Phone:405-473-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator