Healthcare Provider Details

I. General information

NPI: 1801916218
Provider Name (Legal Business Name): CATHERINE ADAMS MCDONOUGH R.N., FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WASHINGTON ST
GLOUCESTER MA
01930-4836
US

IV. Provider business mailing address

27 CONGRESS ST STE 513
SALEM MA
01970-5523
US

V. Phone/Fax

Practice location:
  • Phone: 978-282-8899
  • Fax: 978-282-5599
Mailing address:
  • Phone: 978-744-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN268543
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002965
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN268543
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: