Provider Demographics
NPI:1841758141
Name:LACASSE, REBECCA DAWN (APRN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DAWN
Last Name:LACASSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 KUMMERER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:NH
Mailing Address - Zip Code:03222-6106
Mailing Address - Country:US
Mailing Address - Phone:603-744-5153
Mailing Address - Fax:
Practice Address - Street 1:100 ROBIE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:NH
Practice Address - Zip Code:03222-6063
Practice Address - Country:US
Practice Address - Phone:603-744-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067860-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner