Provider Demographics
NPI:1164298485
Name:LAVERGNE, MICHELLE CHARLOTTE (LP00056456)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHARLOTTE
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:LP00056456
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 252
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244-0252
Mailing Address - Country:US
Mailing Address - Phone:360-922-2076
Mailing Address - Fax:
Practice Address - Street 1:316 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6491
Practice Address - Country:US
Practice Address - Phone:360-922-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse