Individual
JUDY LAVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD-487
HI
363A00000X
Physician Assistant
PA-12486
CA
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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