Provider Demographics
NPI:1982178109
Name:LAVALAIS, LAKRESHA
Entity Type:Individual
Prefix:
First Name:LAKRESHA
Middle Name:
Last Name:LAVALAIS
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 1:2443 TOMICA CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-6919
Mailing Address - Country:US
Mailing Address - Phone:713-449-6834
Mailing Address - Fax:
Practice Address - Street 1:2443 TOMICA CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-6919
Practice Address - Country:US
Practice Address - Phone:713-449-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339291164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse