Provider Demographics
NPI:1548936404
Name:MARTIN, LAVANDA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAVANDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 W PALMETTO ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4909
Mailing Address - Country:US
Mailing Address - Phone:843-799-2649
Mailing Address - Fax:843-799-4224
Practice Address - Street 1:2724 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4909
Practice Address - Country:US
Practice Address - Phone:843-799-2649
Practice Address - Fax:843-799-4224
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236919163WG0000X
247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice