Mary Ann Gagnon, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

CNP81271 Issued in ME

Practice address

31 Colcord St
South Berwick, ME 03908-1004

Phone

(207) 384-4949

Fax

(207) 384-4273

NPI assigned

Aug 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wentworth Douglass Hospital

  • Pain Clinic/Center
  • Portsmouth, NH
  • NPI 1790416774
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1871601948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "207-451-9600",
            "fax_number": "207-451-9603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 COLCORD ST",
            "city": "SOUTH BERWICK",
            "state": "ME",
            "postal_code": "039081004",
            "telephone_number": "207-384-4949",
            "fax_number": "207-384-4273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NH",
            "license": "029774-23",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ME",
            "license": "CNP81271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3075766",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00991109",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "500022875",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871601948",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laneisha Emerson, M.A., BCBA
• Keri R Fernald, LCMHC
• Jessica Jane Fitzgerald, PT
• Lori Anne Ford, MSPT
• Bette Jonas Freedson, LCSW
• William Justin Gilbert, PT
• Great Works Chiropractic & Wellness, PA
• Great Works Family Practice
• Great Works Family Practice
• Great Works Family Practice, P.a.

• Primary Care Nurse Practitioner in South Berwick, ME
• Providers in South Berwick, ME by specialty
• Primary Care Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.