Healthcare Provider Details

I. General information

NPI: 1801535687
Provider Name (Legal Business Name): LAVITA LASHONNA MILLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 MARKET AVE N
CANTON OH
44714-2603
US

IV. Provider business mailing address

1223 MARKET AVE N
CANTON OH
44714-2603
US

V. Phone/Fax

Practice location:
  • Phone: 234-999-4900
  • Fax:
Mailing address:
  • Phone: 234-999-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0031280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: