Provider Demographics
NPI:1881163897
Name:BEAUDOIN, JODY GERMAINE (AGNP)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:GERMAINE
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1065 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAMS
Mailing Address - State:NY
Mailing Address - Zip Code:14812-9741
Mailing Address - Country:US
Mailing Address - Phone:607-684-0050
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2849
Practice Address - Country:US
Practice Address - Phone:607-737-4700
Practice Address - Fax:607-737-9080
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308953-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health