MEDICARE: INGRID AVENT LVN

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	164X00000X	Licensed Vocational Nurse	325821	TX

General Provider Information

NPI Number	:	1619470911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID AVENT LVN

Provider Business Mailing Address
First Line	:	9820 MARYVILLE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4422
Country	:	US
Telephone Number	:	817-500-1946
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 MARYVILLE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4422
Country	:	US
Telephone Number	:	817-500-1946
Fax Number	:

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

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	03/13/2018

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