Healthcare Provider Details

I. General information

NPI: 1578642427
Provider Name (Legal Business Name): NICOLE MARIE GAUGER PMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAWRENCE ST STE 1A
GLENS FALLS NY
12801-4004
US

IV. Provider business mailing address

1 LAWRENCE ST STE 1A
GLENS FALLS NY
12801-4004
US

V. Phone/Fax

Practice location:
  • Phone: 518-201-2250
  • Fax:
Mailing address:
  • Phone: 518-201-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: