Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | SPO15635 | PA |
NPI | 1043678436 |
---|---|
Provider Name | Matthew Thomas Lavelle |
First Address | Pittsburgh, PA 15224-1778 |
Second Address | Pittsburgh, PA 15224-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2016 |
Last Update Date | 02/10/2020 |