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NPI Code Detail

MEDICARE: LISA MARIE GAGNON APRN

MEDICARE: LISA MARIE GAGNON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner002510CT
2363L00000XNurse Practitioner002510CT

General Provider Information

NPI Number : 1417926957
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE GAGNON APRN
Provider Business Mailing Address
First Line : 230 BOSTON POST RD
Second Line :
City : MADISON
State : CT
Zip : 06443-2225
Country : US
Telephone Number : 203-245-0496
Fax Number : 203-245-8697
Provider Business Practice Location Address
First Line : 230 BOSTON POST RD
Second Line :
City : MADISON
State : CT
Zip : 06443-2225
Country : US
Telephone Number : 203-245-0496
Fax Number : 203-245-8697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 08/09/2013

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