Provider Demographics
NPI:1669446456
Name:GAGNON, SHERRY (NP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:GAGNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:HASBRO 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5980
Mailing Address - Fax:401-444-3873
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:CORO WEST
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-444-5980
Practice Address - Fax:401-444-3873
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIAPRN00043363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAPRN00043OtherLICENSE
RI709004047OtherGROUP MEDICARE
RI7058269Medicaid
RI050483739OtherTIN