Provider Demographics
NPI:1750450656
Name:ROY, BRENDA JEAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:ROY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:180 GREEN ST MELROSE MA 02176
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-665-9236
Mailing Address - Fax:
Practice Address - Street 1:BRIGHAM & WOMENS HOSPITAL 75 FRANCIS ST
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-8214
Practice Address - Fax:617-732-6798
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82508367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60550Medicare UPIN
NA0962Medicare ID - Type Unspecified