Provider Demographics
NPI:1689991283
Name:PAGOTTO, GINA ANNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ANNE
Last Name:PAGOTTO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:933 E HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3819
Mailing Address - Country:US
Mailing Address - Phone:610-525-4511
Mailing Address - Fax:610-525-8561
Practice Address - Street 1:933 E HAVERFORD ROAD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3819
Practice Address - Country:US
Practice Address - Phone:610-525-4511
Practice Address - Fax:610-525-8561
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005718C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health