Provider Demographics
NPI:1184230229
Name:LAVIGNE, TAMMY LOUISE
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LOUISE
Last Name:LAVIGNE
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 1:166 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-3566
Mailing Address - Country:US
Mailing Address - Phone:601-965-6749
Mailing Address - Fax:
Practice Address - Street 1:166 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3566
Practice Address - Country:US
Practice Address - Phone:601-965-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide