Individual
DOREEN GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN34980
RI
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN201559
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104847946
THE PROVIDENCE CENTER NPI
RI
05
—
DE22167
—
RI
Enumeration date
09/25/2006
Last updated
01/03/2013
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