Healthcare Provider Details

I. General information

NPI: 1568214005
Provider Name (Legal Business Name): MISLIE NOUGAISSE MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PELHAM ST
METHUEN MA
01844-2060
US

IV. Provider business mailing address

34 HAVERHILL ST
LAWRENCE MA
01841-2884
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-3491
  • Fax:
Mailing address:
  • Phone: 978-686-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2356389
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: