Individual
JUDITH ANN MCGONAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
725 ALBANY ST, SHAPIRO 7, SUITE B, BOSTON, MA 02118-2526
(617) 638-8456
(617) 638-8465
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN198111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110102003A
—
MA
Enumeration date
04/05/2013
Last updated
09/28/2017
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