Provider Demographics
NPI:1548450448
Name:CHAGNON, AIMEE C (MD)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:C
Last Name:CHAGNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1456 PROFESSIONAL DR STE 402
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6639
Mailing Address - Country:US
Mailing Address - Phone:707-938-7951
Mailing Address - Fax:707-938-7260
Practice Address - Street 1:1456 PROFESSIONAL DR STE 402
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6639
Practice Address - Country:US
Practice Address - Phone:707-938-7951
Practice Address - Fax:707-938-7260
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA778242084P2900X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHO49ZOtherPTAN
CA00A778242OtherPTAN
CAFHO49ZOtherPTAN
CA00A778242OtherPTAN