Healthcare Provider Details

I. General information

NPI: 1124018247
Provider Name (Legal Business Name): JORDA DAIGNEAULT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDA CHAPIN

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DH - EMERGENCY DEPT
LEBANON NH
03756-1000
US

IV. Provider business mailing address

PO BOX 216
TOWNSHEND VT
05353-0216
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7254
  • Fax: 603-650-4516
Mailing address:
  • Phone: 802-365-3756
  • Fax: 802-365-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number031162-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: