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General NPI Number Information
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NPI Number | 1881244648
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Entity Type | Individual
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Provider Name | MELISSA LAVRANCHUK
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone | 860-679-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 156 SCHOOL ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-2958
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Country | US
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Telephone |
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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 | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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License Number | 039798
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License Number State | CT
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