Individual
SUSAN GAVAGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-4802
Mailing address
36 TIRRELL ST, QUINCY, MA 02171-1653
(617) 328-0645
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
128628
MA
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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