Provider Demographics
NPI:1770937617
Name:GAGNON, JENNIFER CLAIRE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:GAGNON
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:2807 N. GLEBE ROAD
Mailing Address - Street 2:MARYMOUNT UNIVERSITY, STUDENT HEALTH
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:703-284-1610
Mailing Address - Fax:703-284-3816
Practice Address - Street 1:2807 N. GLEBE ROAD
Practice Address - Street 2:MARYMOUNT UNIVERSITY, STUDENT HEALTH
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:703-284-1610
Practice Address - Fax:703-284-3816
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2020-10-27
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Provider Licenses
StateLicense IDTaxonomies
VA0024169116363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics