=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316604119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER THOMAS LAVIGNE NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2021
-----------------------------------------------------
Last Update Date | 11/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 VETERANS MEMORIAL PKWY STE 7A
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-5315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-741-0127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 BATTEY ST APT 5
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-543-7583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN02935
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------