Provider Demographics
NPI:1952632333
Name:FOGARTY, LYNDA MARGARET (RN)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:MARGARET
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 FORISTALL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-2228
Mailing Address - Country:US
Mailing Address - Phone:978-297-0583
Mailing Address - Fax:978-297-0583
Practice Address - Street 1:484 FORISTALL RD
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-2228
Practice Address - Country:US
Practice Address - Phone:978-297-0583
Practice Address - Fax:978-297-0583
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN211964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse