Provider Demographics
NPI:1821120064
Name:TEKIN, BRENDA RUTH (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RUTH
Last Name:TEKIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 VERA DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3149
Mailing Address - Country:US
Mailing Address - Phone:508-697-0819
Mailing Address - Fax:
Practice Address - Street 1:45 VERA DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3149
Practice Address - Country:US
Practice Address - Phone:508-697-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701416OtherMASSHEALTH PROVIDER NUMBE