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General NPI Number Information
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NPI Number | 1053356758
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Entity Type | Individual
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Provider Name | CHERYL GAGNON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-864-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MYERS CT
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6409
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Country | US
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Telephone | 802-864-0111
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0550031022
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License Number State | VT
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