Provider Demographics
NPI:1154547230
Name:BURNS, LAVELLA ELIZABETH (LMP)
Entity type:Individual
Prefix:
First Name:LAVELLA
Middle Name:ELIZABETH
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 F ST SE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1943
Mailing Address - Country:US
Mailing Address - Phone:509-398-5877
Mailing Address - Fax:
Practice Address - Street 1:150 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1602
Practice Address - Country:US
Practice Address - Phone:509-398-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist