Provider Demographics
NPI:1912355165
Name:CHATMON, LAVEETTA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:LAVEETTA
Middle Name:MICHELLE
Last Name:CHATMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAVEETTA
Other - Middle Name:MICHELLE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 TOBIN DR APT 310
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1391
Mailing Address - Country:US
Mailing Address - Phone:313-465-9554
Mailing Address - Fax:
Practice Address - Street 1:401 TOBIN DR APT 310
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1391
Practice Address - Country:US
Practice Address - Phone:313-465-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other