Provider Demographics
NPI:1215060983
Name:CHAGNON, JUDITH LEACH (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LEACH
Last Name:CHAGNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3451
Mailing Address - Country:US
Mailing Address - Phone:315-384-3044
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH CTR
Practice Address - Street 2:CLARKSON UNIVERSITY
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13699-0001
Practice Address - Country:US
Practice Address - Phone:315-268-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300006-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health