Provider Demographics
NPI:1639422355
Name:LIENKAMP, BRIANNE P (RN, ANP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:P
Last Name:LIENKAMP
Suffix:
Gender:F
Credentials:RN, ANP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1538
Mailing Address - Country:US
Mailing Address - Phone:508-748-3736
Mailing Address - Fax:508-748-3767
Practice Address - Street 1:369 FRONT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1538
Practice Address - Country:US
Practice Address - Phone:404-798-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276384363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110076590AMedicaid
MA110107382AMedicaid