| Doctor Name: | MARY ANN GAGNON |
| NPI Number: | 1871601948 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 029774-23 |
| Business Practice Address: | 19 Levesque Dr Suite 2 Eliot, ME - 039032079 |
| Business Phone Number: | 2074519600 |
| Business Fax Number: | 2074519603 |
| Mailing Address: | 789 Central Ave, DOVER |
| State: | NH |
| Postal Code: | 038202526 |
| Phone Number: | 2074519600 |
| Fax Number: | 2074519603 |
| NPI Enumeration Date: | 08/28/2006 |
| NPI Last Update Date: | 02/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 029774-23 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |