Provider Demographics
NPI:1629282041
Name:MCDONOUGH, VERONICA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:ANN
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 FOWLE ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-5725
Mailing Address - Country:US
Mailing Address - Phone:781-937-0089
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:RHODES HALL-STUDENT HEALTH SERVICES
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4713
Practice Address - Country:US
Practice Address - Phone:781-891-2222
Practice Address - Fax:781-891-3443
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily