Provider Demographics
NPI:1437897808
Name:GAGNON, RHONDA (APRN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:GAGNON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CTR BARNSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03225-3354
Mailing Address - Country:US
Mailing Address - Phone:603-556-1360
Mailing Address - Fax:
Practice Address - Street 1:41800 W 11 MILE RD STE 109
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1818
Practice Address - Country:US
Practice Address - Phone:833-578-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068822-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology