Provider Demographics
NPI:1104541432
Name:GAGNE, CHELSEA LEE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:LEE
Last Name:GAGNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVERBEND ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2542
Mailing Address - Country:US
Mailing Address - Phone:978-467-7002
Mailing Address - Fax:
Practice Address - Street 1:57 CITY HALL AVE
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2614
Practice Address - Country:US
Practice Address - Phone:978-630-3862
Practice Address - Fax:978-630-4176
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF10220376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily