Healthcare Provider Details

I. General information

NPI: 1306855937
Provider Name (Legal Business Name): VALERIE L. LAVALLEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE LYNN MORSE PAC

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELLIOT WAY SUITE 200
MANCHESTER NH
03103-3547
US

IV. Provider business mailing address

4 ELLIOT WAY SUITE 200
MANCHESTER NH
03103-3547
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-9200
  • Fax: 603-624-2210
Mailing address:
  • Phone: 603-669-9200
  • Fax: 603-624-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052549
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number534
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: