Provider Demographics
NPI:1336955285
Name:MATHIEU, MAGALIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MAGALIE
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MAGALIE
Other - Middle Name:
Other - Last Name:GODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 STEBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5030
Mailing Address - Country:US
Mailing Address - Phone:857-236-2574
Mailing Address - Fax:
Practice Address - Street 1:61 STEBBINS AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5030
Practice Address - Country:US
Practice Address - Phone:857-236-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse