| NPI | 1922476324 |
|---|---|
| Former Name | AMY LAVIGNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4137) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 149158-2) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R 149158-2) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2023-07-18 |