Provider Demographics
NPI:1164404604
Name:LAVIOLETTE, JANET D (APRN, BC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:D
Last Name:LAVIOLETTE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:187 WILMOT RD
Mailing Address - City:OCEAN BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11770-0412
Mailing Address - Country:US
Mailing Address - Phone:631-583-9655
Mailing Address - Fax:
Practice Address - Street 1:158 EAST MAIN STREET
Practice Address - Street 2:OCEAN FAMILY MEDICINE
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-5634
Practice Address - Fax:631-665-5639
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF331874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily