Provider Demographics
NPI:1841950748
Name:LAVENDER, SAMANTHA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1341
Mailing Address - Country:US
Mailing Address - Phone:216-825-3159
Mailing Address - Fax:
Practice Address - Street 1:1424 GORDON RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1341
Practice Address - Country:US
Practice Address - Phone:216-825-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.404413163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant