Healthcare Provider Details

I. General information

NPI: 1134345697
Provider Name (Legal Business Name): MICHELLE GAHAGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 23RD AVE N
NASHVILLE TN
37203-1503
US

IV. Provider business mailing address

311 23RD AVE N
NASHVILLE TN
37203-1503
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-5647
  • Fax: 615-340-2115
Mailing address:
  • Phone: 615-340-5647
  • Fax: 615-340-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number155999
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number155999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: