Individual
IVAN DOUGLAS LAVENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3086 STATE ROUTE 160, GALLIPOLIS, OH 45631-8409
(740) 446-5500
(740) 446-4951
Mailing address
PO BOX 188, CHILLICOTHE, OH 45601-0188
(740) 773-4366
(740) 775-7855
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.020695
OH
Other
Enumeration date
04/27/2017
Last updated
10/29/2019
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