Provider Demographics
NPI:1245347483
Name:LAVIGNE, PAUL D (EMT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 3569
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114
Mailing Address - Country:DE
Mailing Address - Phone:0964-192-5870
Mailing Address - Fax:
Practice Address - Street 1:USAHC GRAF CMR 415
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114
Practice Address - Country:DE
Practice Address - Phone:0964-183-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB1498591374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician