Provider Demographics
NPI:1861540031
Name:LAVIGNE, JANE ANN (APN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EXECUTIVE PARK DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3717
Mailing Address - Country:US
Mailing Address - Phone:518-435-1231
Mailing Address - Fax:518-512-3574
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3717
Practice Address - Country:US
Practice Address - Phone:518-435-1231
Practice Address - Fax:518-512-3574
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY367062-1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY131837OtherVALUEOPTIONS
NY7493042002OtherGHI
NY01941813Medicaid
NY378070OtherMVP
NY378070OtherMVP