Individual
KRYSTAL KAY LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 N WASHINGTON ST, BOURBON, IN 46504-1623
(574) 335-7850
(574) 335-0755
Mailing address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008330A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102236362
ANTHEM
IN
05
—
300020124
—
IN
Enumeration date
05/01/2018
Last updated
10/03/2024
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