Provider Demographics
NPI:1154340834
Name:LAVIGNIAC, JUDITH MICHELLE (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MICHELLE
Last Name:LAVIGNIAC
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIDGETOP RD
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-1628
Mailing Address - Country:US
Mailing Address - Phone:508-477-6805
Mailing Address - Fax:508-224-2175
Practice Address - Street 1:1233 STATE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5133
Practice Address - Country:US
Practice Address - Phone:508-224-7701
Practice Address - Fax:508-224-2175
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122942363LF0000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1126Medicare ID - Type UnspecifiedPROVIDER NUMBER