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General NPI Number Information
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NPI Number | 1043805088
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Entity Type | Individual
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Provider Name | JESSICA CAITLIN GAGEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 455 W 4TH ST STE 100
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City | FOSTORIA
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State | OH
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Zip | 44830-1864
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Country | US
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Telephone | 419-436-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 SAND RIDGE RD
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City | BOWLING GREEN
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State | OH
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Zip | 43402-4493
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Country | US
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Telephone | 419-806-7812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0028343
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License Number State | OH
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