Basic Information
| Provider Information | |||||||||
| NPI: | 1356544241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAY | ||||||||
| FirstName: | MARY ANN | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 WARREN ST | ||||||||
| Address2: | UNIT B | ||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024923029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888978947 | ||||||||
| FaxNumber: | 6177725519 | ||||||||
| Practice Location | |||||||||
| Address1: | 253 SUMMER ST | ||||||||
| Address2: | 5TH FLR - CMA | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022101114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888978947 | ||||||||
| FaxNumber: | 6177725519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 123532 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
No ID Information.