Healthcare Provider Details

I. General information

NPI: 1265473946
Provider Name (Legal Business Name): JANET LAVALLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE STE 5800
FORT GEORGE G MEADE MD
20755-5129
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8798
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR138878
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: