| NPI | 1124456736 |
|---|---|
| Former Name | CARLY GAGNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209019723) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2014001970) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2024-09-18 |