Individual
LAVERNE C JIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 3090, KAYENTA, AZ 86033-3090
(928) 429-5701
Mailing address
PO BOX 3090, KAYENTA, AZ 86033-3090
(928) 429-5701
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33-5017492
—
AZ
Enumeration date
06/25/2025
Last updated
06/25/2025
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