Provider Demographics
NPI:1124018247
Name:DAIGNEAULT, JORDA (APRN)
Entity Type:Individual
Prefix:
First Name:JORDA
Middle Name:
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JORDA
Other - Middle Name:
Other - Last Name:CHAPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353-0216
Mailing Address - Country:US
Mailing Address - Phone:802-365-3756
Mailing Address - Fax:802-365-3641
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DH - EMERGENCY DEPT
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-7254
Practice Address - Fax:603-650-4516
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031162-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT370052OtherMVP
40Y007281NH02OtherANTHEM NH
VT48124OtherVTBLUE
VT7787901OtherVMC
VT0NP1858Medicaid
NH30340399Medicaid
NH3077758Medicaid
40Y007281NH01OtherANTHEM NH
435571NHOtherCIGNA
VT48124OtherVTBLUE
NH3077758Medicaid