Individual
BRENDA LEFAVOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 CONWAY CT, TROY, NY 12180-2108
(518) 274-6525
(518) 274-6511
Mailing address
284 4TH ST, TROY, NY 12180-4601
(518) 274-6525
(518) 274-6511
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
298302
NY
Other
Enumeration date
05/03/2010
Last updated
05/03/2010
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