Provider Information for 1801463872
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LAVERNA SOUCIE
Sex: Female
NPI: 1801463872
Last Updated: 2025-01-27
Certification Date: 2025-01-27
Certification Date: 2025-01-27
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1801463872 | ||||||||||||||||||||
| Enumeration Date | 2021-06-08 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | PO BOX 220395 EL PASO, TX 79913-2395 United States Phone: | Fax: | ||||||||||||||||||||
| Primary Practice Address | 2435 E SOUTHLAKE BLVD STE 100 SOUTHLAKE, TX 76092-6679 United States Phone: 817-812-2880 | Fax: | ||||||||||||||||||||
| Secondary Practice Address(es) | 1801 WYOMING AVE | ||||||||||||||||||||
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