Provider Demographics
NPI:1952695553
Name:SEYFRIED, LAVENIA J (ANP)
Entity Type:Individual
Prefix:
First Name:LAVENIA
Middle Name:J
Last Name:SEYFRIED
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RD MEDICAL GROUP SGHC
Mailing Address - Street 2:3278 MITCHELL BLVD. MOODY AFB, GA. 31699-1500
Mailing Address - City:MOODY AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31699-1500
Mailing Address - Country:US
Mailing Address - Phone:229-257-3681
Mailing Address - Fax:229-257-4381
Practice Address - Street 1:23 RD MEDICAL GROUP SGHC
Practice Address - Street 2:3278 MITCHELL BLVD. MOODY AFB, GA. 31699-1500
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-1500
Practice Address - Country:US
Practice Address - Phone:229-257-1918
Practice Address - Fax:229-257-4381
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN134946163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse