Provider Demographics
NPI:1306855937
Name:LAVALLEE, VALERIE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:L
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VALERIE
Other - Middle Name:LYNN
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:4 ELLIOT WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3547
Mailing Address - Country:US
Mailing Address - Phone:603-669-9200
Mailing Address - Fax:603-624-2210
Practice Address - Street 1:4 ELLIOT WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3547
Practice Address - Country:US
Practice Address - Phone:603-669-9200
Practice Address - Fax:603-624-2210
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052549363A00000X
NH534363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29366Medicare UPIN