Provider Demographics
NPI:1205035656
Name:LAVALLEE, PATRICIA RITA (RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RITA
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WILLISTON WAY
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3528
Mailing Address - Country:US
Mailing Address - Phone:401-640-5909
Mailing Address - Fax:
Practice Address - Street 1:61 WILLISTON WAY
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-3528
Practice Address - Country:US
Practice Address - Phone:401-640-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268343163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708372OtherMASS HEALTH PROVIDER NUMB
RIRN35980OtherRI RN LISCENSE #
MA268343OtherMASS RN LICENSE #