Provider Demographics
NPI:1376927335
Name:NORBRUN, GUERLINE
Entity Type:Individual
Prefix:
First Name:GUERLINE
Middle Name:
Last Name:NORBRUN
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 1:607 PLEASANT ST STE 115
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2570
Mailing Address - Country:US
Mailing Address - Phone:508-223-4691
Mailing Address - Fax:
Practice Address - Street 1:607 PLEASANT ST STE 115
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2570
Practice Address - Country:US
Practice Address - Phone:508-223-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN275285363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS110112988AMedicaid
MAS400306370OtherMEDICARE
MAS400289767OtherMEDICARE