Healthcare Provider Details

I. General information

NPI: 1154340834
Provider Name (Legal Business Name): JUDITH MICHELLE LAVIGNIAC APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 STATE RD
PLYMOUTH MA
02360-5133
US

IV. Provider business mailing address

7 RIDGETOP RD
FORESTDALE MA
02644-1628
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-7701
  • Fax: 508-224-2175
Mailing address:
  • Phone: 508-477-6805
  • Fax: 508-224-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122942
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number122942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: