Individual
KELLEY LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
119 BELMONT ST, WORCESTER, MA 01605-2903
(508) 334-6206
(508) 334-6083
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN246110
MA
363LN0000X
Neonatal Nurse Practitioner
APRN01247
RI
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
RN246110
MA
363LP0200X
Pediatric Nurse Practitioner
CNPP37216
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110127839A
—
MA
Enumeration date
08/02/2010
Last updated
03/30/2021
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