Provider Demographics
NPI:1487277844
Name:LAKE HAVASU UNIFIED SCHOOL DISTRCT
Entity type:Organization
Organization Name:LAKE HAVASU UNIFIED SCHOOL DISTRCT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL LPN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:928-680-6082
Mailing Address - Street 1:1250 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-8764
Mailing Address - Country:US
Mailing Address - Phone:928-680-6082
Mailing Address - Fax:
Practice Address - Street 1:1250 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-8764
Practice Address - Country:US
Practice Address - Phone:928-680-6082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty