1962747667 NPI number — MAGGIE G LAVENDER FNP

Table of content: MAGGIE G LAVENDER FNP (NPI 1962747667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962747667 NPI number — MAGGIE G LAVENDER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVENDER
Provider First Name:
MAGGIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962747667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 COCHRAN RD # MANOR2
Provider Second Line Business Mailing Address:
SUITE 490
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15220-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-531-2902
Provider Business Mailing Address Fax Number:
412-531-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3928 WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-941-8877
Provider Business Practice Location Address Fax Number:
724-941-4745
Provider Enumeration Date:
12/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  753139 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)