Provider Demographics
NPI:1598523037
Name:GOGUEN, MONIQUE ROSE (NP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ROSE
Last Name:GOGUEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAK RIDGE DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2471
Mailing Address - Country:US
Mailing Address - Phone:617-538-7600
Mailing Address - Fax:
Practice Address - Street 1:55 HIGHLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2100
Practice Address - Country:US
Practice Address - Phone:978-741-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner