1588804686 NPI number — MRS. THERESA NAOMI MACDOUGALL CERTIFIED NURSE PRAC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588804686 NPI number — MRS. THERESA NAOMI MACDOUGALL CERTIFIED NURSE PRAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDOUGALL
Provider First Name:
THERESA
Provider Middle Name:
NAOMI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSE PRAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUTER
Provider Other First Name:
THERESA
Provider Other Middle Name:
NAOMI
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED NURSE PRAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588804686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
531 FAUNCE CORNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-3991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN284223 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN03228 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: SP010165 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 951695 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110171739A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1583237 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2099584 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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