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General NPI Number Information
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NPI Number | 1083704829
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Entity Type | Individual
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Provider Name | LYNN BUJNEVICIE LAROCHELLE PAC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 300 STAFFORD ST #154
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City | SPRINGFIELD
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State | MA
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Zip | 01104-4110
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Country | US
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Telephone | 413-781-5735
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Fax |
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Provider Business Mailing Address
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Address Line | 300 STAFFORD ST #154
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City | SPRINGFIELD
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State | MA
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Zip | 01104-4110
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Country | US
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Telephone | 413-781-5735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA1379
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001164
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1379
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License Number State | MA
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