Provider Demographics
NPI:1861981292
Name:ALEXANDER, LAVONNE L (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAVONNE
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAVONNE
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 LAKE GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48370-2406
Mailing Address - Country:US
Mailing Address - Phone:248-408-8344
Mailing Address - Fax:
Practice Address - Street 1:4500 S SAGINAW ST STE 1875
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-275-9151
Practice Address - Fax:810-396-6773
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily