Provider Demographics
NPI:1306566872
Name:STEPHENS, LAVONDA LYNN
Entity type:Individual
Prefix:MRS
First Name:LAVONDA
Middle Name:LYNN
Last Name:STEPHENS
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 1:833 E BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2840
Mailing Address - Country:US
Mailing Address - Phone:717-353-2607
Mailing Address - Fax:
Practice Address - Street 1:833 E BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2840
Practice Address - Country:US
Practice Address - Phone:717-353-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant