Provider Demographics
NPI:1043737711
Name:WHITLEY, BRIANNE (RN)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:WHITLEY
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 1:71 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1825
Mailing Address - Country:US
Mailing Address - Phone:781-635-4909
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5450
Practice Address - Country:US
Practice Address - Phone:617-632-3800
Practice Address - Fax:617-632-1930
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2312306163WH0200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health