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NPI Code Detail

MEDICARE: ANDREA JOY GAGNON RN

MEDICARE: ANDREA JOY GAGNON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN2272437MA

General Provider Information

NPI Number : 1154999142
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA JOY GAGNON RN
Provider Business Mailing Address
First Line : 55 GIFFORD AVE
Second Line :
City : DARTMOUTH
State : MA
Zip : 02747-2419
Country : US
Telephone Number : 402-310-1421
Fax Number :
Provider Business Practice Location Address
First Line : 301 STATE AVE
Second Line :
City : TIVERTON
State : RI
Zip : 02878-1062
Country : US
Telephone Number : 402-310-1421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2021
Last Update Date : 06/15/2021

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