Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 199708 | MA |
NPI | 1043452394 |
---|---|
Provider Name | Denise Gagnon |
First Address | New Bedford, MA 02740 |
Second Address | New Bedford, MA 02740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 01/04/2009 |