Provider Demographics
NPI:1992499651
Name:LAVINDER, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LAVINDER
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 1:639 HELENA AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3602
Mailing Address - Country:US
Mailing Address - Phone:406-594-6972
Mailing Address - Fax:
Practice Address - Street 1:639 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3602
Practice Address - Country:US
Practice Address - Phone:406-594-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT57528175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist