Provider Demographics
NPI:1861016743
Name:LAFOND, MEREDITH ELISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ELISE
Last Name:LAFOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 4TH AVE SE APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1625
Mailing Address - Country:US
Mailing Address - Phone:413-348-0740
Mailing Address - Fax:
Practice Address - Street 1:624 4TH AVE SE APT 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1625
Practice Address - Country:US
Practice Address - Phone:413-348-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant