Provider Demographics
NPI:1811157480
Name:DRESSEN, LA VAYE D
Entity type:Individual
Prefix:
First Name:LA VAYE
Middle Name:D
Last Name:DRESSEN
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 1:225 PAUL BUNYAN DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2433
Mailing Address - Country:US
Mailing Address - Phone:218-751-1073
Mailing Address - Fax:
Practice Address - Street 1:225 PAUL BUNYAN DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2433
Practice Address - Country:US
Practice Address - Phone:218-751-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist