Individual
LAVERNE ANNETTA FENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
351 CHATTERLY LN, COLUMBUS, OH 43207-5335
(614) 398-6151
Mailing address
351 CHATTERLY LN, COLUMBUS, OH 43207-5335
(614) 398-6151
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
376JOOOOOX-HOMEMAKER
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2720416
—
OH
Enumeration date
08/28/2013
Last updated
08/28/2013
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