Provider Demographics
NPI:1467503318
Name:GAYNOR, JAMES J
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-0272
Mailing Address - Country:US
Mailing Address - Phone:603-863-3788
Mailing Address - Fax:603-863-2753
Practice Address - Street 1:120 RTE 10
Practice Address - Street 2:SAWYER BROOK PLAZA- SUITE 10
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-3788
Practice Address - Fax:603-863-2753
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035921-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health