MEDICARE: AYVEE LAVENDER FNP-C

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	363LF0000X	Family Nurse Practitioner	AP136033	TX
2	363LF0000X	Family Nurse Practitioner	A166587	IA
3	363LF0000X	Family Nurse Practitioner	5015429	NC

General Provider Information

NPI Number	:	1912403676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYVEE LAVENDER FNP-C

Provider Business Mailing Address
First Line	:	6805 DWIGHT ROWLAND RD
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-0105
Country	:	US
Telephone Number	:	919-737-2561
Fax Number	:	828-800-9712

Provider Business Practice Location Address
First Line	:	6805 DWIGHT ROWLAND RD
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-0105
Country	:	US
Telephone Number	:	919-737-2561
Fax Number	:	828-800-9712

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	09/29/2022

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