Healthcare Provider Details

I. General information

NPI: 1922169127
Provider Name (Legal Business Name): JOHN ROBERT NUGENT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 SHARON ST PACT TEAM TRI CITY MENTAL HEALTH CENTER
MALDEN MA
02148
US

IV. Provider business mailing address

246 WEST STREET
READING MA
01867
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-8800
  • Fax: 781-397-2108
Mailing address:
  • Phone: 781-944-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number175275
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: