=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124404793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAVONNA LYNNSILEE ALVERA NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2015
-----------------------------------------------------
Last Update Date | 08/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 E SUPERIOR ST
-----------------------------------------------------
City | ALMA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48801-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-796-4555
-----------------------------------------------------
Fax | 989-285-1674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5135 S PENNSYLVANIA AVE
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-887-5922
-----------------------------------------------------
Fax | 517-887-5982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 4704267166
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4704267166
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------