Healthcare Provider Details

I. General information

NPI: 1003142894
Provider Name (Legal Business Name): JEANNE LAVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST
WALTON NY
13856-1218
US

IV. Provider business mailing address

37 DIETZ ST
ONEONTA NY
13820-1882
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6579
  • Fax:
Mailing address:
  • Phone: 607-432-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number237914-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: