Healthcare Provider Details

I. General information

NPI: 1235096470
Provider Name (Legal Business Name): JUSTINE GAGNON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW STE 4-200
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

2400 JENNIFER CT
CLARKSBURG MD
20871-8530
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-6783
  • Fax:
Mailing address:
  • Phone: 202-476-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1030272
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: