Healthcare Provider Details

I. General information

NPI: 1104778380
Provider Name (Legal Business Name): MICHELLE LAVALLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 2ND ST
DULUTH MN
55805-1913
US

IV. Provider business mailing address

4036 LAVAQUE RD
HERMANTOWN MN
55811-3668
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-8762
  • Fax:
Mailing address:
  • Phone: 218-390-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR155130-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: