Provider Demographics
NPI:1841569720
Name:LIVINGSTON LAVALLEE, HEATHER ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:LIVINGSTON LAVALLEE
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:100 FODEN ROAD
Mailing Address - Street 2:WEST BUILDING SUITE 103
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2351
Mailing Address - Country:US
Mailing Address - Phone:207-828-1122
Mailing Address - Fax:207-828-0188
Practice Address - Street 1:100 FODEN ROAD
Practice Address - Street 2:WEST BUILDING SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2351
Practice Address - Country:US
Practice Address - Phone:207-828-1122
Practice Address - Fax:207-828-0188
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2015-11-16
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Provider Licenses
StateLicense IDTaxonomies
MECNP111096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily