Basic Information
| Provider Information | |||||||||
| NPI: | 1235431222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACASSE | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037561000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036504000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18 OLD ETNA RD | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036504000 | ||||||||
| FaxNumber: | 6036504090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 101.00742949 | VT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 067106-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1018407 | 05 | VT | MEDICAID |