Provider Demographics
NPI:1679381123
Name:LAVAN, JENNIE (APN)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:LAVAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SAND DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2763
Mailing Address - Country:US
Mailing Address - Phone:609-462-9363
Mailing Address - Fax:
Practice Address - Street 1:650 TOWN BANK RD UNIT 201
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-4420
Practice Address - Country:US
Practice Address - Phone:609-551-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15241500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health