Provider Demographics
NPI:1891593455
Name:BIRCH, LA'TAVIONA LA'VE
Entity type:Individual
Prefix:
First Name:LA'TAVIONA
Middle Name:LA'VE
Last Name:BIRCH
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 1:6120 FONTENELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1143
Mailing Address - Country:US
Mailing Address - Phone:531-203-7757
Mailing Address - Fax:
Practice Address - Street 1:14210 ARBOR ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2382
Practice Address - Country:US
Practice Address - Phone:531-999-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant