Provider Demographics
NPI:1316085806
Name:LAPIERRE, KELLIE LAVIN (GNP- BC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LAVIN
Last Name:LAPIERRE
Suffix:
Gender:F
Credentials:GNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4425
Mailing Address - Country:US
Mailing Address - Phone:508-655-5549
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-431-2345
Practice Address - Fax:781-239-9966
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173339363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology