Jenna Gagnon I

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Pepperell, MA

NPI 1194196634 · NPPES record last updated Oct 9, 2015

Key facts

NPI
1194196634
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
32A Elm St
Pepperell, MA 01463-1603
Phone
(978) 502-9969
NPI assigned
Oct 9, 2015
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

32A Elm St
Pepperell, MA 01463-1603

Mailing address

32A Elm St
Pepperell, MA 01463-1603
Phone (978) 502-9969

Other providers in Pepperell, MA

All providers in Pepperell, MA · Student in an Organized Health Care Education/Training Program in Massachusetts

Sources for this page

Verify at the official NPI Registry.