Individual
SUSAN ELLEN GAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
87 LIAM LANE, CENTERVILLE, MA 02632-3354
(508) 420-9726
(508) 420-8204
Mailing address
87 LIAM LANE, CENTERVILLE, MA 02632-3354
(508) 420-9726
(508) 420-8204
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
94922
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0378241
—
MA
Enumeration date
08/15/2006
Last updated
07/09/2007
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