Provider Demographics
NPI:1699943811
Name:FUCHS, LAVONNA
Entity type:Individual
Prefix:MS
First Name:LAVONNA
Middle Name:
Last Name:FUCHS
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 1:4913 E ROUGHRIDER CIR
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1036
Mailing Address - Country:US
Mailing Address - Phone:701-426-5439
Mailing Address - Fax:
Practice Address - Street 1:4913 E ROUGHRIDER CIR
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1036
Practice Address - Country:US
Practice Address - Phone:701-328-8888
Practice Address - Fax:701-328-8900
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 3747P1801X
ND3567171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27505OtherBLUECROSS/BLUESHIELD
ND74004Medicaid