1659055135 NPI number — ABIGAYLE VICTORIA GOUDREAU DNP

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 1659055135 NPI number — ABIGAYLE VICTORIA GOUDREAU DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOUDREAU
Provider First Name:
ABIGAYLE
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOUDREAU
Provider Other First Name:
ABIGAYLE
Provider Other Middle Name:
VICTORIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ABIGAYLE SIDUR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659055135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-8885
Provider Business Mailing Address Fax Number:
508-334-1977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 E OLD STURBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIMFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01010-9647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-765-3145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2023

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: 363L00000X , with the licence number:  RN2316635 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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