Provider Demographics
NPI:1659055135
Name:GOUDREAU, ABIGAYLE VICTORIA (DNP)
Entity Type:Individual
Prefix:
First Name:ABIGAYLE
Middle Name:VICTORIA
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MRS
Other - First Name:ABIGAYLE
Other - Middle Name:VICTORIA
Other - Last Name:GOUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABIGAYLE SIDUR
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:255 E OLD STURBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9647
Practice Address - Country:US
Practice Address - Phone:508-765-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner