MEDICARE: MRS. ROBIN LYNN LAVIS DEM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1740430735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN LYNN LAVIS DEM

Provider Business Mailing Address
First Line	:	12473 BUSSA RD
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9620
Country	:	US
Telephone Number	:	231-264-9144
Fax Number	:	231-264-9144

Provider Business Practice Location Address
First Line	:	12473 BUSSA RD
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9620
Country	:	US
Telephone Number	:	231-264-9144
Fax Number	:	231-264-9144

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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