Basic Information
| Provider Information | |||||||||
| NPI: | 1942817689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYNARD | ||||||||
| FirstName: | BRENNA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 FATIMA DR | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028094738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015759974 | ||||||||
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| Practice Location | |||||||||
| Address1: | 277 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027213005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763292 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2020 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN2308899 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.