Provider Demographics
NPI:1851521215
Name:GAGNE HENDERSON, REBECCA (PHD, NP-C FNP ACHPN)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GAGNE HENDERSON
Suffix:
Gender:F
Credentials:PHD, NP-C FNP ACHPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:GAGNE-HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, NP-C FNP ACHPN
Mailing Address - Street 1:6400 SHAFER CT STE 700
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4989
Mailing Address - Country:US
Mailing Address - Phone:346-376-1702
Mailing Address - Fax:224-532-2780
Practice Address - Street 1:1579 STRAITS TPKE STE 1E
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-490-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily