Provider Demographics
NPI:1861006140
Name:WU, BRANDON TIMOTHY (MSN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:TIMOTHY
Last Name:WU
Suffix:
Gender:M
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-1647
Mailing Address - Country:US
Mailing Address - Phone:508-361-3391
Mailing Address - Fax:
Practice Address - Street 1:5 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MA
Practice Address - Zip Code:02030-1647
Practice Address - Country:US
Practice Address - Phone:508-361-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335632363LP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse