Basic Information
| Provider Information | |||||||||
| NPI: | 1699943811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUCHS | ||||||||
| FirstName: | LAVONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4913 E ROUGHRIDER CIR | ||||||||
| Address2: | |||||||||
| City: | MANDAN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585541036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014265439 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4913 E ROUGHRIDER CIR | ||||||||
| Address2: | |||||||||
| City: | MANDAN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585541036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013288888 | ||||||||
| FaxNumber: | 7013288900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 04/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 3747P1801X | N | Nursing Service Related Providers | Technician | Personal Care Attendant | 171M00000X | 3567 | ND | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 27505 | 01 | ND | BLUECROSS/BLUESHIELD | OTHER | 74004 | 05 | ND | MEDICAID |