Provider Demographics
NPI:1386188704
Name:GAGNE, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GAGNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 E 2ND ST # 136
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5313
Mailing Address - Country:US
Mailing Address - Phone:405-757-9532
Mailing Address - Fax:
Practice Address - Street 1:3001 S DOUGLAS BLVD
Practice Address - Street 2:BUILDING 1094
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1003
Practice Address - Country:US
Practice Address - Phone:405-757-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136790163WF0300X, 163WA2000X, 163WC1400X, 163WG0000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health