Provider Demographics
NPI:1578680575
Name:LAVALLIE, DONNA L (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:LAVALLIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:LAVALLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:15205 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2016
Mailing Address - Country:US
Mailing Address - Phone:206-852-1782
Mailing Address - Fax:
Practice Address - Street 1:1100 VIRGINIA ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1439
Practice Address - Country:US
Practice Address - Phone:206-682-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine