Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 232267 | MA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 232267 | MA |
NPI | 1003824392 |
---|---|
Provider Name | Mrs. Maura Moran Brain |
First Address | Boston, MA 02215-5400 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 11/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q08150 | (02) | MA |