Provider Demographics
NPI:1801945969
Name:LAVIGNE, DEBRA (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5429
Mailing Address - Country:US
Mailing Address - Phone:607-257-5263
Mailing Address - Fax:607-216-0902
Practice Address - Street 1:209 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5429
Practice Address - Country:US
Practice Address - Phone:607-257-5263
Practice Address - Fax:607-216-0902
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3017681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF3017681OtherNYS LICENSE NUMBER
NY01777779Medicaid
NY01777779Medicaid
NYP81983Medicare UPIN
NYDD4553Medicare ID - Type UnspecifiedMEDICARE NUMBER