MEDICARE: MRS. LAVONDA ANN MASSEY LPN

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	164W00000X	Licensed Practical Nurse	PN 076370	OH

General Provider Information

NPI Number	:	1871708073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAVONDA ANN MASSEY LPN

Provider Business Mailing Address
First Line	:	2807 SOUTHFIELD VILLAGE DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4735
Country	:	US
Telephone Number	:	614-539-7876
Fax Number	:	614-539-7876

Provider Business Practice Location Address
First Line	:	2807 SOUTHFIELD VILLAGE DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4735
Country	:	US
Telephone Number	:	614-539-7876
Fax Number	:	614-539-7876

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/09/2007

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