| NPI | 1760089445 |
|---|---|
| Former Name | MARA NICOLE LAVELLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71011419A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28224434A) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2022-05-09 |