Doctor Name: | DENISE GAGNON |
NPI Number: | 1043452394 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 199708 |
Business Practice Address: | 874 Purchase St. New Bedford, MA - 02740 |
Business Phone Number: | 5089926553 |
Business Fax Number: | 5089907558 |
Mailing Address: | 874 Purchase St., Greater New Bedford Community Health Center NEW BEDFORD |
State: | MA |
Postal Code: | 02740 |
Phone Number: | 5089926553 |
Fax Number: | 5089907558 |
NPI Enumeration Date: | 04/01/2009 |
NPI Last Update Date: | 04/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 199708 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |