Provider Demographics
NPI:1730654815
Name:DUROSEAU, BRENICE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENICE
Middle Name:
Last Name:DUROSEAU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4666
Mailing Address - Country:US
Mailing Address - Phone:443-738-4731
Mailing Address - Fax:
Practice Address - Street 1:2601 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4666
Practice Address - Country:US
Practice Address - Phone:443-738-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7702363LF0000X
MDR243625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily