Healthcare Provider Details

I. General information

NPI: 1417772500
Provider Name (Legal Business Name): SALLY ANNE MCGOWAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 WORCESTER RD STE 501
FRAMINGHAM MA
01701-5405
US

IV. Provider business mailing address

405 S MAIN ST
COHASSET MA
02025-2065
US

V. Phone/Fax

Practice location:
  • Phone: 781-254-6185
  • Fax:
Mailing address:
  • Phone: 781-254-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN170804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: