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NPI Code Detail

MEDICARE: LYNN MARIE LACAVERA

MEDICARE: LYNN MARIE LACAVERA
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
1163WA0400XAddiction (Substance Use Disorder) Registered Nurse4704168991MI

General Provider Information

NPI Number : 1609947555
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN MARIE LACAVERA
Provider Business Mailing Address
First Line : 13120 GILBERT RD
Second Line :
City : RILEY
State : MI
Zip : 48041-3401
Country : US
Telephone Number : 810-392-3583
Fax Number :
Provider Business Practice Location Address
First Line : 400 STODDARD RD
Second Line :
City : RICHMOND
State : MI
Zip : 48062-2505
Country : US
Telephone Number : 810-392-3583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/08/2007

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Directions to “ LYNN MARIE LACAVERA ” Practice Location

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