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General NPI Number Information
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NPI Number | 1760631923
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Entity Type | Individual
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Provider Name | BRENDA VIGUE
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Gender | Female
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 40 CHURCH ST
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City | LOWELL
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State | MA
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Zip | 01852-6113
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Country | US
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Telephone | 978-674-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 58 JERSEY ST
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City | DEDHAM
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State | MA
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Zip | 02026-4915
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Country | US
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Telephone | 617-640-3857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 194285
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP8053
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 194285
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License Number State | MA
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