MEDICARE: CRISTINA FRANCES GAGNON PA-C

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
1	363A00000X	Physician Assistant	085.009422	IL
2	363A00000X	Physician Assistant	10003993A	IN
3	363A00000X	Physician Assistant	5601011449	MI
4	363A00000X	Physician Assistant	021326	NY
5	363A00000X	Physician Assistant	MA064545	PA
6	363A00000X	Physician Assistant	7391-23	WI
7	363A00000X	Physician Assistant	50.006410RX	OH

General Provider Information

NPI Number	:	1528582335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA FRANCES GAGNON PA-C

Provider Business Mailing Address
First Line	:	2880 STELZER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 STELZER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3133
Country	:	US
Telephone Number	:	833-620-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	04/25/2024

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