Healthcare Provider Details

I. General information

NPI: 1699943811
Provider Name (Legal Business Name): MS. LAVONNA FUCHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 04/30/2022
Certification Date: 04/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 E ROUGHRIDER CIR
MANDAN ND
58554-1036
US

IV. Provider business mailing address

4913 E ROUGHRIDER CIR
MANDAN ND
58554-1036
US

V. Phone/Fax

Practice location:
  • Phone: 701-328-8888
  • Fax: 701-328-8900
Mailing address:
  • Phone: 701-426-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number3567
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: