Provider Demographics
NPI:1467878579
Name:LAVALLEE, JANE M (RN, CGRN)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:RN, CGRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROXBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2107
Mailing Address - Country:US
Mailing Address - Phone:508-713-5157
Mailing Address - Fax:508-856-3981
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3767
Practice Address - Fax:508-856-3981
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN262177163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology