Provider Demographics
NPI:1659854248
Name:LAVOIE, DAVID C (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-0064
Mailing Address - Country:US
Mailing Address - Phone:401-837-4803
Mailing Address - Fax:
Practice Address - Street 1:38 MYRICKS ST
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1809
Practice Address - Country:US
Practice Address - Phone:508-386-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2296271163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management