Healthcare Provider Details

I. General information

NPI: 1649415845
Provider Name (Legal Business Name): LINDA HELEN LAVALLEE ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 ROOSEVELT TRL
WINDHAM ME
04062-4904
US

IV. Provider business mailing address

582 ROOSEVELT TRL
WINDHAM ME
04062-4904
US

V. Phone/Fax

Practice location:
  • Phone: 207-892-3233
  • Fax: 207-810-4990
Mailing address:
  • Phone: 207-892-3233
  • Fax: 207-810-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number198710
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP211217
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: