Provider Demographics
NPI:1275308793
Name:GALLUCCI, MEAGHEN ANN (MSN, APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:MEAGHEN
Middle Name:ANN
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 WATERTOWN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1354
Mailing Address - Country:US
Mailing Address - Phone:781-250-9756
Mailing Address - Fax:
Practice Address - Street 1:724 WATERTOWN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1354
Practice Address - Country:US
Practice Address - Phone:781-250-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232331163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health