Healthcare Provider Details

I. General information

NPI: 1508634981
Provider Name (Legal Business Name): LILLIE LAROCHELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT STREET
SPRINGFIELD MA
01107-1619
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9939
  • Fax: 413-794-8166
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2389717
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: