Provider Demographics
NPI:1285971556
Name:LAVELLE, MARY ELLEN (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19928 HIBICUS DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469
Mailing Address - Country:US
Mailing Address - Phone:561-372-9905
Mailing Address - Fax:772-264-8400
Practice Address - Street 1:19928 HIBISCUS DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-2193
Practice Address - Country:US
Practice Address - Phone:561-372-9905
Practice Address - Fax:772-264-8400
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9212455174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator