Healthcare Provider Details

I. General information

NPI: 1932445665
Provider Name (Legal Business Name): KATHERINE RITA DUGAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST # 11PC
BROCKTON MA
02301
US

IV. Provider business mailing address

940 BELMONT ST PRIMARY CARE 11PC
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-2778
  • Fax: 774-826-3157
Mailing address:
  • Phone: 774-826-2778
  • Fax: 774-826-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.005264
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2270215
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12.005264
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2270215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: