| Doctor Name: | SUSAN MARIA LAVELLE |
| NPI Number: | 1124226931 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | NP 17209 |
| Business Practice Address: | 16319 Third Street Guerneville, CA - 95446 |
| Business Phone Number: | 7078692849 |
| Business Fax Number: | 7078691477 |
| Mailing Address: | 8690 Petaluma Hill Rd, PENNGROVE |
| State: | CA |
| Postal Code: | 949518734 |
| Phone Number: | 7079920030 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LC1500X |
| License Number: | NP 17209 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |