Individual
COURTNEY LEANN LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6664 GLENWOOD RD, WILMER, AL 36587-9536
(251) 234-0203
Mailing address
6664 GLENWOOD RD, WILMER, AL 36587-9536
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S12712
AL
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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