MEDICARE: LAURENE ANNE PLOURDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1043853799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURENE ANNE PLOURDE

Provider Business Mailing Address
First Line	:	455 W CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 W CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1637
Country	:	US
Telephone Number	:	508-443-4863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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