Provider Demographics
NPI:1134992829
Name:BAYNE, BRITTANY ADDISON (CPNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ADDISON
Last Name:BAYNE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CROWN DR UNIT 402
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5496
Mailing Address - Country:US
Mailing Address - Phone:860-502-7005
Mailing Address - Fax:
Practice Address - Street 1:53 MA-130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2361529363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty