Provider Demographics
NPI:1912092180
Name:GAGNON, LAURIE-MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAURIE-MARIE
Middle Name:
Last Name:GAGNON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MCGREGOR ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3765
Mailing Address - Country:US
Mailing Address - Phone:603-647-9325
Mailing Address - Fax:603-647-2453
Practice Address - Street 1:87 MCGREGOR ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-647-9325
Practice Address - Fax:603-647-2453
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196731367500000X
NH017104-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R40890Medicare UPIN
MANA054301Medicare PIN
NHNA054302Medicare PIN