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General NPI Number Information
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NPI Number | 1740373331
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Entity Type | Individual
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Provider Name | JENNIFER ANN GAGNON CNM
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 30 N CHURCH ST STE 300
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City | WAILUKU
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State | HI
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Zip | 96793-1600
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Country | US
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Telephone | 808-242-9787
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Fax | 888-972-5617
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Provider Business Mailing Address
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Address Line | 30 N CHURCH ST STE 300
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City | WAILUKU
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State | HI
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Zip | 96793-1600
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Country | US
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Telephone | 808-242-9787
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Fax | 888-972-5617
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APRN-2398
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License Number State | HI
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