Provider Demographics
NPI:1548647209
Name:LAVENDER, MELISSA J (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 METAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4311
Mailing Address - Country:US
Mailing Address - Phone:504-838-6000
Mailing Address - Fax:504-835-6685
Practice Address - Street 1:519 METAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4311
Practice Address - Country:US
Practice Address - Phone:504-838-6000
Practice Address - Fax:504-835-6685
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily