Provider Demographics
NPI:1902342454
Name:KAVUN, ALISSA (LPN)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:KAVUN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TAPPAN AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4106
Mailing Address - Country:US
Mailing Address - Phone:631-452-6022
Mailing Address - Fax:
Practice Address - Street 1:30 TAPPAN AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4106
Practice Address - Country:US
Practice Address - Phone:631-452-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse