Provider Demographics
NPI:1275930166
Name:GWAZE, BRENDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:GWAZE
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 1:11 IRVING ST
Mailing Address - Street 2:# 2
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5232
Mailing Address - Country:US
Mailing Address - Phone:978-760-1825
Mailing Address - Fax:
Practice Address - Street 1:11 IRVING ST
Practice Address - Street 2:# 2
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5232
Practice Address - Country:US
Practice Address - Phone:978-760-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse