Provider Demographics
NPI:1578437067
Name:LAVOIE, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SKARET RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06027-1316
Mailing Address - Country:US
Mailing Address - Phone:860-942-6754
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1837
Practice Address - Country:US
Practice Address - Phone:860-528-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTF09250136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily