Individual
DEBRA LAVIGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
209 W STATE ST, ITHACA, NY 14850-5429
(607) 257-5263
(607) 216-0902
Mailing address
209 W STATE ST, ITHACA, NY 14850-5429
(607) 257-5263
(607) 216-0902
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F3017681
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01777779
—
NY
01
—
F3017681
NYS LICENSE NUMBER
NY
Enumeration date
01/09/2007
Last updated
03/07/2023
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