Individual
MRS. LAVINA JACOB GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
85 SEYMOUR ST, SUITE 900, HARTFORD, CT 06106-5501
(860) 241-0700
(860) 525-7881
Mailing address
2110 SILAS DEANE HWY, ROCKY HILL, CT 06067-2313
(860) 258-3480
(860) 571-6800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011516
CT
363A00000X
Physician Assistant
011516
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011516
LICENSE
CT
Enumeration date
01/25/2007
Last updated
12/18/2011
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