1073662839 NPI number — PAULA KAY LAVIGNE CRNA

Table of content: SHIRLEY SAINT JEAN (NPI 1508202482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073662839 NPI number — PAULA KAY LAVIGNE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVIGNE
Provider First Name:
PAULA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HROBAK
Provider Other First Name:
PAULA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073662839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 OLD WASHBURN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARIBOU
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04736-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-472-6516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 WAYMAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAR HARBOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04609-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-661-2018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RNA183036 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RN557462 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APN3307 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AN1608 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104682 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101858638 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".