| NPI | 1871842609 |
|---|---|
| Former Name | MALLORY SUE LAVIGNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NH 066476-21) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2013-02-28 |