Healthcare Provider Details

I. General information

NPI: 1821390519
Provider Name (Legal Business Name): MONICA E TAGUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 SOMERVILLE AVE
SOMERVILLE MA
02143-2914
US

IV. Provider business mailing address

337 SOMERVILLE AVE
SOMERVILLE MA
02143-2914
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3370
  • Fax: 617-625-1288
Mailing address:
  • Phone: 617-665-3370
  • Fax: 617-625-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number691125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: