Provider Demographics
NPI:1114095262
Name:NUGENT, MARY P
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:NUGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3220
Mailing Address - Country:US
Mailing Address - Phone:401-421-9000
Mailing Address - Fax:401-421-5588
Practice Address - Street 1:293 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3220
Practice Address - Country:US
Practice Address - Phone:401-421-9000
Practice Address - Fax:401-421-5588
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01203363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINPP17692OtherSTATE LICENSE