Healthcare Provider Details

I. General information

NPI: 1336406479
Provider Name (Legal Business Name): LAVEE KEONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W APACE ST
FARMINGTON NM
87401
US

IV. Provider business mailing address

807 W APACE ST
FARMINGTON NM
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5358
  • Fax: 505-327-1482
Mailing address:
  • Phone: 505-325-5358
  • Fax: 505-327-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: