Most Relevant Information
Provider Data
| NPI Number: | 1003587312 |
| Provider Name: | COURTNEY GAVIGAN FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 1521377 |
Most Important Dates
| Enumeration Date: | 09/26/2021 |
| Last Updated: | 09/26/2021 |
Provider Practice Location
396 BROADWAY
KINGSTON
NY
124014626
Practice Location Phone/Fax
| Phone: | 8453313131 |
| Fax: |
Provider Mailing Location
396 BROADWAY
KINGSTON
NY
124014626
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |