Provider Demographics
NPI:1629383435
Name:LAVELLE, LAURA C (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1768
Mailing Address - Country:US
Mailing Address - Phone:415-377-5707
Mailing Address - Fax:650-756-1491
Practice Address - Street 1:5925 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8537
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily