Provider Demographics
NPI:1053520783
Name:LAVEZZI, JINNY REBECCA (DO)
Entity type:Individual
Prefix:DR
First Name:JINNY
Middle Name:REBECCA
Last Name:LAVEZZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JINNY
Other - Middle Name:REBECCA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4401 WORNALL RD
Mailing Address - Street 2:ROOM 2710
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3220
Mailing Address - Country:US
Mailing Address - Phone:816-932-2493
Mailing Address - Fax:816-932-6139
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:ROOM 2710
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2493
Practice Address - Fax:816-932-6139
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO467292080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine