Basic Information
| Provider Information | |||||||||
| NPI: | 1952415747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAVIGNE | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 GIFFORD ST | ||||||||
| Address2: | PEDIATRICS | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132043201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157032600 | ||||||||
| FaxNumber: | 3157032621 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 GIFFORD ST | ||||||||
| Address2: | PEDIATRICS | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132043201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157032600 | ||||||||
| FaxNumber: | 3157032621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 02/21/2015 | ||||||||
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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 | 363LP0200X | F-380747 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 163WP0200X | 282073 | NY | N | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.