Individual
VLASTA D LAVALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
40 HOLLAND ST, INTERNAL MEDICINE, SOMERVILLE, MA 02144-2705
(617) 629-6350
(617) 629-6067
Mailing address
147 MILK ST, PROVIDER ENROLLMENT, 9TH FLOOR, BOSTON, MA 02109-4806
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
258436
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
258436
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0711594
—
MA
Enumeration date
03/05/2007
Last updated
06/12/2012
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