Provider Demographics
NPI:1376274167
Name:MEEHAN-BRESE, BRIGID JOANNA
Entity Type:Individual
Prefix:
First Name:BRIGID
Middle Name:JOANNA
Last Name:MEEHAN-BRESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CENTER OF TOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05048-9595
Mailing Address - Country:US
Mailing Address - Phone:802-595-3862
Mailing Address - Fax:
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT101.0135577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program