Provider Demographics
NPI:1508070533
Name:GAGNER, CECILE R (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CECILE
Middle Name:R
Last Name:GAGNER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19507 99TH ST. CT. E.
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-833-1833
Mailing Address - Fax:253-833-4642
Practice Address - Street 1:821 HARVEY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4225
Practice Address - Country:US
Practice Address - Phone:253-833-1833
Practice Address - Fax:253-833-4642
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012142171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor