Individual
AMANDA DAWN LAVALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2430 EMERALD PL STE 201, GREENVILLE, NC 27834-5743
(252) 752-2140
Mailing address
2430 EMERALD PL STE 201, GREENVILLE, NC 27834-5743
(252) 752-2140
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202019
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
2108
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
87169
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063706638
TRICARE
NC
05
—
8054132
—
NC
01
—
P01042929
RAILROAD MEDICARE
NC
Enumeration date
06/01/2011
Last updated
06/26/2026
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