Healthcare Provider Details

I. General information

NPI: 1003927088
Provider Name (Legal Business Name): MARY K MCGOURTY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 MAIN ST
PEPPERELL MA
01463-1560
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 978-433-6317
  • Fax: 978-433-0567
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225962
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: