Individual
LAKESHIA REVERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
Mailing address
3440 AVON ROAD, APT L-343, DEVON, PA 19333
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN274832
PA
Other
Enumeration date
10/21/2009
Last updated
10/21/2009
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