Provider Demographics
NPI:1730909326
Name:FOGUE, PRISCILLE (RN)
Entity type:Individual
Prefix:
First Name:PRISCILLE
Middle Name:
Last Name:FOGUE
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 1:158 CONCORD RD APT H21
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-4638
Mailing Address - Country:US
Mailing Address - Phone:413-777-6955
Mailing Address - Fax:
Practice Address - Street 1:158 CONCORD RD APT H21
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-4638
Practice Address - Country:US
Practice Address - Phone:413-777-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10016041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse