Individual
JENNIFER A LAVIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
130 2ND ST, NEENAH, WI 54956-2883
(920) 729-2738
(920) 729-3021
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3200
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3111
WI
364S00000X
Clinical Nurse Specialist
Primary
152277
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
711290026
MEDICARE PTAN
WI
Enumeration date
06/13/2007
Last updated
08/16/2012
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