Healthcare Provider Details

I. General information

NPI: 1487981528
Provider Name (Legal Business Name): MARY THERESE DUGGAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY THERESE DUGGAN-GILBERT NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

38 RESERVOIR RD
COHASSET MA
02025-1622
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6034
  • Fax:
Mailing address:
  • Phone: 781-383-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number168981
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: