Basic Information
| Provider Information | |||||||||
| NPI: | 1982159539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LESSARD-CHAUDOIN | ||||||||
| FirstName: | CHANTELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPH, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7699 E PINNACLE PEAK RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852556322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803004663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7699 E PINNACLE PEAK RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803004663 | ||||||||
| FaxNumber: | 4803004888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2016 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Z170211 | 01 | AZ | MEDICARE | OTHER |