Provider Demographics
NPI:1912729096
Name:CORRIVEAU, JASON VAL (LPN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:VAL
Last Name:CORRIVEAU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DRAGON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-2115
Mailing Address - Country:US
Mailing Address - Phone:774-200-9351
Mailing Address - Fax:
Practice Address - Street 1:16 DRAGON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-2115
Practice Address - Country:US
Practice Address - Phone:774-200-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN58235164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse