Provider Demographics
NPI:1932501798
Name:BLACK, BRENDA MACPHERSON (MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MACPHERSON
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LYNN
Other - Last Name:MACPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 MCFARLIN RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2803
Mailing Address - Country:US
Mailing Address - Phone:617-640-2133
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:ELLISON 219
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-0182
Practice Address - Country:US
Practice Address - Phone:617-724-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN195628363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily