Provider Demographics
NPI:1740373331
Name:GAGNON, JENNIFER ANN (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:GAGNON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N CHURCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1600
Mailing Address - Country:US
Mailing Address - Phone:808-242-9787
Mailing Address - Fax:888-972-5617
Practice Address - Street 1:30 N CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1600
Practice Address - Country:US
Practice Address - Phone:808-242-9787
Practice Address - Fax:888-972-5617
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2398367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife