Healthcare Provider Details

I. General information

NPI: 1497272397
Provider Name (Legal Business Name): GRACE A LAVALLEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 307
TACOMA WA
98405-5305
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 307
TACOMA WA
98405-5305
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-1244
  • Fax: 253-627-6576
Mailing address:
  • Phone: 253-627-1244
  • Fax: 253-627-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN269757
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61512075
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61512075
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: