Provider Demographics
NPI:1255889549
Name:DURGIN, JADE ASHTON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:ASHTON
Last Name:DURGIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JADE
Other - Middle Name:ASHTON
Other - Last Name:REDFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:424 OLD STREET ROAD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458
Mailing Address - Country:US
Mailing Address - Phone:603-924-4668
Mailing Address - Fax:603-924-4669
Practice Address - Street 1:424 OLD STREET ROAD SUITE 201
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458
Practice Address - Country:US
Practice Address - Phone:603-924-4668
Practice Address - Fax:603-924-4669
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1205363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1205OtherSTATE LICENSE