Provider Demographics
NPI:1518276575
Name:VAN DE WATER, BRITTNEY JAYNE (PNP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:JAYNE
Last Name:VAN DE WATER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:JAYNE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:288 LYMAN ST
Mailing Address - Street 2:DYS MEDICAL
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:774-442-5624
Mailing Address - Fax:
Practice Address - Street 1:288 LYMAN ST
Practice Address - Street 2:DYS MEDICAL
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:774-442-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260882363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics