Healthcare Provider Details

I. General information

NPI: 1457123887
Provider Name (Legal Business Name): EMMA LOUISE DAGESSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST
WESTON MA
02493-1572
US

IV. Provider business mailing address

235 WELLESLEY ST
WESTON MA
02493-1572
US

V. Phone/Fax

Practice location:
  • Phone: 781-768-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2318441
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: