Provider Demographics
NPI:1700226818
Name:HOOGASIAN, MAGLENES FAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MAGLENES
Middle Name:FAY
Last Name:HOOGASIAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BOYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2570
Mailing Address - Country:US
Mailing Address - Phone:508-829-6765
Mailing Address - Fax:508-829-1884
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2570
Practice Address - Country:US
Practice Address - Phone:508-829-6765
Practice Address - Fax:508-829-1884
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN211044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110096734AMedicaid