Provider Demographics
NPI:1801399886
Name:LEARY, BRIENNE SARAH (MSN, RN, CPNP-PC/AC)
Entity Type:Individual
Prefix:MRS
First Name:BRIENNE
Middle Name:SARAH
Last Name:LEARY
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC/AC
Other - Prefix:MS
Other - First Name:BRIENNE
Other - Middle Name:SARAH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:85 BRAINERD RD APT 310
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4562
Mailing Address - Country:US
Mailing Address - Phone:339-223-0773
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:339-223-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA270184363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics