Provider Demographics
NPI:1871871897
Name:LALONDE, LOLA S
Entity type:Individual
Prefix:MS
First Name:LOLA
Middle Name:S
Last Name:LALONDE
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 1:1220 8TH ST SE LOT 29
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2717
Mailing Address - Country:US
Mailing Address - Phone:218-841-3500
Mailing Address - Fax:
Practice Address - Street 1:1220 8TH ST SE LOT 29
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2717
Practice Address - Country:US
Practice Address - Phone:218-841-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor