Healthcare Provider Details

I. General information

NPI: 1548450448
Provider Name (Legal Business Name): AIMEE C CHAGNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 PROFESSIONAL DR STE 402
PETALUMA CA
94954-6639
US

IV. Provider business mailing address

1456 PROFESSIONAL DR STE 402
PETALUMA CA
94954-6639
US

V. Phone/Fax

Practice location:
  • Phone: 707-938-7951
  • Fax: 707-938-7260
Mailing address:
  • Phone: 707-938-7951
  • Fax: 707-938-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA77824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: