Healthcare Provider Details

I. General information

NPI: 1679684864
Provider Name (Legal Business Name): MRS. NANCY L MCGONEGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 344-E
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 344-E
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-0749
  • Fax: 610-621-4087
Mailing address:
  • Phone: 978-927-0749
  • Fax: 610-621-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: