Doctor Name: | LYNNE L GAGON |
NPI Number: | 1154408805 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN-BC |
License Number: | 203926-4405 |
Business Practice Address: | 147 E Main St Vernal, UT - 840782643 |
Business Phone Number: | 4357815746 |
Business Fax Number: | |
Mailing Address: | Po Box 516, JENSEN |
State: | UT |
Postal Code: | 840350516 |
Phone Number: | 4357815476 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0809X |
License Number: | 203926-4405 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Psych/Mental Health, Adult |
Taxonomy Definition: |