Basic Information
| Provider Information | |||||||||
| NPI: | 1427499698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAROCQUE | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ESSEX CENTER DR | ||||||||
| Address2: | LAHEY NORTHSHORE | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019602901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785384674 | ||||||||
| FaxNumber: | 9785384712 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 BORTHWICK AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034315242 | ||||||||
| FaxNumber: | 6034315091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2285106 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.