Individual
BETTY MARIE LAVALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
5899 MILITARY TPKE, ELLENBURG DEPOT, NY 12935-3016
(518) 594-3742
Mailing address
5899 MILITARY TPKE, ELLENBURG DEPOT, NY 12935-3016
(518) 594-3742
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
289489-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02905631
—
NY
Enumeration date
02/09/2008
Last updated
02/09/2008
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