Healthcare Provider Details

I. General information

NPI: 1487612438
Provider Name (Legal Business Name): CHERYL DAGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SPRING ST
LACONIA NH
03246-3113
US

IV. Provider business mailing address

85 SPRING ST.
LACONIA NH
03246-3113
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-7402
  • Fax:
Mailing address:
  • Phone: 603-524-7402
  • Fax: 603-227-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA197
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: