MEDICARE: LAVONDA HUNISE DESLANDES CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	174837	WI
2	376K00000X	Nurse's Aide	174837	WI

General Provider Information

NPI Number	:	1316373509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONDA HUNISE DESLANDES CNA

Provider Business Mailing Address
First Line	:	4642 W MELVINA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2339
Country	:	US
Telephone Number	:	414-736-1275
Fax Number	:

Provider Business Practice Location Address
First Line	:	4642 W MELVINA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2339
Country	:	US
Telephone Number	:	414-736-1275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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