MEDICARE: MS. LINDA HELEN LAVALLEE ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	198710	MA
2	363LA2200X	Adult Health Nurse Practitioner	CNP211217	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ML0622527I	OTHER	MA	STATE CONTROLLED SUBSTANCE REGISTRATION

General Provider Information

NPI Number	:	1649415845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA HELEN LAVALLEE ANP-BC

Provider Business Mailing Address
First Line	:	582 ROOSEVELT TRL
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-4904
Country	:	US
Telephone Number	:	207-892-3233
Fax Number	:	207-810-4990

Provider Business Practice Location Address
First Line	:	582 ROOSEVELT TRL
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-4904
Country	:	US
Telephone Number	:	207-892-3233
Fax Number	:	207-810-4990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	03/02/2026

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