Provider Demographics
NPI:1417772500
Name:MCGOWAN, SALLY ANNE (RN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:MCGOWAN
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 1:405 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-2065
Mailing Address - Country:US
Mailing Address - Phone:781-254-6185
Mailing Address - Fax:
Practice Address - Street 1:1661 WORCESTER RD STE 501
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5405
Practice Address - Country:US
Practice Address - Phone:781-254-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN170804163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty