Provider Demographics
NPI:1215813167
Name:GILMORE, LAVONYA RENEE (CNA)
Entity type:Individual
Prefix:MS
First Name:LAVONYA
Middle Name:RENEE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142-9218
Mailing Address - Country:US
Mailing Address - Phone:803-553-6068
Mailing Address - Fax:
Practice Address - Street 1:128 HARVARD LN
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-9218
Practice Address - Country:US
Practice Address - Phone:803-553-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC560553376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide