Provider Demographics
NPI:1043805054
Name:LAUDERDALE, LAVERNE
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:LAUDERDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 PEARL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3814
Mailing Address - Country:US
Mailing Address - Phone:440-317-4070
Mailing Address - Fax:
Practice Address - Street 1:6500 PEARL RD STE 209
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3814
Practice Address - Country:US
Practice Address - Phone:440-317-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherIN PROGRESS