Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN211074 | MA |
NPI | 1003282963 |
---|---|
Provider Name | Marlene A Brady |
First Address | Burlington, MA 01803-4758 |
Second Address | Burlington, MA 01803-4758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2015 |
Last Update Date | 14/08/2015 |