Healthcare Provider Details

I. General information

NPI: 1437776655
Provider Name (Legal Business Name): PAULINE N MONGO-SHEI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WEST ST
LEOMINSTER MA
01453-2099
US

IV. Provider business mailing address

PO BOX 2153 DEPT 40338
BIRMINGHAM AL
35287-9386
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-0771
  • Fax:
Mailing address:
  • Phone: 706-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2280840
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: