Provider Demographics
NPI:1013081421
Name:ZYLSTRA, BRENDA CHARLENE (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CHARLENE
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD 5
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:100 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NORTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01534-1415
Practice Address - Country:US
Practice Address - Phone:508-234-6260
Practice Address - Fax:508-234-0764
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA193835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ02683Medicare UPIN