Provider Demographics
NPI:1164021929
Name:LAVALLIE, CHASITY MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:MICHELLE
Last Name:LAVALLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1884
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1884
Mailing Address - Country:US
Mailing Address - Phone:701-278-2244
Mailing Address - Fax:
Practice Address - Street 1:4461 BIA ROAD 10 # 842
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-7706
Practice Address - Country:US
Practice Address - Phone:701-278-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant