Provider Demographics
NPI:1871708073
Name:MASSEY, LAVONDA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAVONDA
Middle Name:ANN
Last Name:MASSEY
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 1:2807 SOUTHFIELD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4735
Mailing Address - Country:US
Mailing Address - Phone:614-539-7876
Mailing Address - Fax:614-539-7876
Practice Address - Street 1:2807 SOUTHFIELD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4735
Practice Address - Country:US
Practice Address - Phone:614-539-7876
Practice Address - Fax:614-539-7876
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 076370164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH212-3731Medicare UPIN