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General NPI Number Information
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NPI Number | 1922280817
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH GAGNON
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Gender | Female
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 652 GEORGE WASHINGTON HWY UNIT 400
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City | LINCOLN
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State | RI
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Zip | 02865-4267
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Country | US
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Telephone | 401-334-1830
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Fax | 401-334-1833
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Provider Business Mailing Address
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Address Line | PO BOX 9014
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City | WARWICK
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State | RI
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Zip | 02889-0014
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Country | US
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Telephone | 401-859-3335
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Fax | 401-246-4655
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | APRN00356
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN04102
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN211088
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License Number State | MA
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