Provider Demographics
NPI:1154008969
Name:GAGNON, JOANNE CARDOSO (RN, CLC)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:CARDOSO
Last Name:GAGNON
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 JEAN CAROL RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2639
Mailing Address - Country:US
Mailing Address - Phone:360-609-5319
Mailing Address - Fax:
Practice Address - Street 1:181 JEAN CAROL RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2639
Practice Address - Country:US
Practice Address - Phone:360-609-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343546163WL0100X
MARN255032163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant