Healthcare Provider Details

I. General information

NPI: 1699762864
Provider Name (Legal Business Name): MAUREEN ANN GAUGHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN O'NEIL

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TARKILN ROAD
KINGSTON MA
02364-1250
US

IV. Provider business mailing address

75 WASHINGTON ST
NORWELL MA
02061-1795
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-1784
  • Fax: 781-585-2200
Mailing address:
  • Phone: 781-878-5200
  • Fax: 781-878-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number92659
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: