Provider Demographics
NPI:1912926551
Name:WAINWRIGHT, LAVERNE (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4256 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3691
Mailing Address - Country:US
Mailing Address - Phone:313-622-6928
Mailing Address - Fax:
Practice Address - Street 1:4256 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3691
Practice Address - Country:US
Practice Address - Phone:313-622-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224837163WC0400X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management