Provider Demographics
NPI:1437438173
Name:LAVERRIERE, LEYA RAE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEYA
Middle Name:RAE
Last Name:LAVERRIERE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:PEDIATRIC SURGERY
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-669-4985
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:PEDIATRIC SURGERY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-669-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NH0843363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant