Healthcare Provider Details

I. General information

NPI: 1811921125
Provider Name (Legal Business Name): SARAH A LAVALETTE CRNA,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 COLUMBUS AVE # 291
BOSTON MA
02116-6008
US

IV. Provider business mailing address

398 COLUMBUS AVE # 291
BOSTON MA
02116-6008
US

V. Phone/Fax

Practice location:
  • Phone: 617-797-4682
  • Fax:
Mailing address:
  • Phone: 617-797-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number175104
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.04023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: