Individual
LAVONDA FLANNIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-7375
(817) 702-2787
Mailing address
9825 MAGNOLIA AVE STE B, RIVERSIDE, CA 92503-3565
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2500834
MN
163W00000X
Registered Nurse
Primary
988991
TX
164X00000X
Licensed Vocational Nurse
281266
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11241000383
—
CA
Enumeration date
07/21/2014
Last updated
02/19/2024
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