Healthcare Provider Details

I. General information

NPI: 1487356119
Provider Name (Legal Business Name): LINNEA JOFFE-NELSON GAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINNEA JOFFE-NELSON

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-4010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2358486
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2358486
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: