Healthcare Provider Details

I. General information

NPI: 1629748116
Provider Name (Legal Business Name): JENNIFER GAGNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ATWOOD RD
PELHAM NH
03076-3751
US

IV. Provider business mailing address

49 ATWOOD RD STE 1
PELHAM NH
03076-3752
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2802
  • Fax:
Mailing address:
  • Phone: 603-398-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number064536-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: