Provider Demographics
NPI:1417617184
Name:GAGNE, VANESSA J (RN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:GAGNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SPRAGUE TOWN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-2806
Mailing Address - Country:US
Mailing Address - Phone:518-860-9021
Mailing Address - Fax:
Practice Address - Street 1:340 SPRAGUE TOWN RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-2806
Practice Address - Country:US
Practice Address - Phone:518-860-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673534-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health