Healthcare Provider Details

I. General information

NPI: 1598142648
Provider Name (Legal Business Name): LA VONDA WHEELING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVONDA TABRON

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6047 TYVOLA GLEN CIR STE 100
CHARLOTTE NC
28217-6431
US

IV. Provider business mailing address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152-9477
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax:
Mailing address:
  • Phone: 443-383-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number303770
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number81366
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017320
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017320
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTABR-6V19Z
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: