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General NPI Number Information
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NPI Number | 1679381123
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Entity Type | Individual
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Provider Name | JENNIE LAVAN APN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 650 TOWN BANK RD UNIT 201
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City | CAPE MAY
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State | NJ
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Zip | 08204-4420
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Country | US
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Telephone | 609-551-4356
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Fax |
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Provider Business Mailing Address
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Address Line | 11 SAND DOLLAR DR
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City | CAPE MAY COURT HOUSE
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State | NJ
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Zip | 08210-2763
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Country | US
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Telephone | 609-462-9363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ15241500
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License Number State | NJ
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