Provider Demographics
NPI:1013587047
Name:FOGUE, GRACE MEGWO (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MEGWO
Last Name:FOGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2220
Mailing Address - Country:US
Mailing Address - Phone:413-320-8521
Mailing Address - Fax:
Practice Address - Street 1:5 WINTER ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2220
Practice Address - Country:US
Practice Address - Phone:413-320-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse