Healthcare Provider Details

I. General information

NPI: 1568595429
Provider Name (Legal Business Name): DARLAINE J LAVIOLETTE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/25/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 KINSLEY ST STE 20
NASHUA NH
03060-3634
US

IV. Provider business mailing address

C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-3365
  • Fax: 603-883-5758
Mailing address:
  • Phone: 207-777-8695
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number064799-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR47098
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number064799-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: