Provider Demographics
NPI:1184608358
Name:EGAN, DENISE (APRN-BC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FARNUM RD
Mailing Address - Street 2:PO BOX 1415
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-3602
Mailing Address - Country:US
Mailing Address - Phone:781-294-8970
Mailing Address - Fax:
Practice Address - Street 1:353 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1903
Practice Address - Country:US
Practice Address - Phone:781-659-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177104163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAEG-NP5074Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #