Provider Demographics
NPI:1669298196
Name:LAVELLE, MARY JOAN (MSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ASH GAP RD
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6286
Mailing Address - Country:US
Mailing Address - Phone:570-903-4480
Mailing Address - Fax:
Practice Address - Street 1:116 ASH GAP RD
Practice Address - Street 2:
Practice Address - City:SPRING BROOK TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-6286
Practice Address - Country:US
Practice Address - Phone:570-903-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN539170163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical