Provider Demographics
NPI:1821373887
Name:KAGUNGO, MONICAH (FNP)
Entity Type:Individual
Prefix:MISS
First Name:MONICAH
Middle Name:
Last Name:KAGUNGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WELLESLEY STREET
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493
Mailing Address - Country:US
Mailing Address - Phone:781-281-0420
Mailing Address - Fax:
Practice Address - Street 1:22 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1284
Practice Address - Country:US
Practice Address - Phone:978-448-3388
Practice Address - Fax:978-448-9979
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN277013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily