Provider Demographics
NPI:1629815949
Name:BRITT, ANGELIQUE (RN, LIC AC)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:BRITT
Suffix:
Gender:F
Credentials:RN, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CHARLEMONT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01339-9708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 MAIN ST STE 2I
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039-9766
Practice Address - Country:US
Practice Address - Phone:413-320-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257237163W00000X
171100000X
MA6014163171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse