Provider Demographics
NPI:1073662839
Name:LAVIGNE, PAULA KAY (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:HROBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:127 OLD WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-4142
Mailing Address - Country:US
Mailing Address - Phone:843-472-6516
Mailing Address - Fax:
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-661-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA183036367500000X
PARN557462367500000X, 367500000X
SCAPN3307367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1608Medicaid
PA104682OtherGEISINGER HEALTH PLAN
PA101858638Medicaid
PA101858638Medicaid
PA109209Medicare ID - Type Unspecified