Gagnon, Mary Lou

Gagnon, Mary Lou is an individual health care provider with primary practice located at 44405 Woodward Ave , Pontiac MI 48341-5023. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Gagnon, Mary Lou can be contacted via phone (248) 858-6593.

Contact Information

Primary practice address
44405 Woodward Ave Pontiac MI 48341-5023
Phone: (248) 858-6593
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 4704160281 Michigan

Profile Details

NPI number 1952583445
LBN Legal business name Gagnon, Mary Lou
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 27th, 2007
Last updated Jun 24th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952583445 NPPES
Michigan MEDICAID 437785110

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