Provider Demographics
NPI:1932217130
Name:COLVIN, BRENDA L (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:COLVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2442
Mailing Address - Country:US
Mailing Address - Phone:508-223-2474
Mailing Address - Fax:508-431-1515
Practice Address - Street 1:159 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2442
Practice Address - Country:US
Practice Address - Phone:508-223-2474
Practice Address - Fax:508-431-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9928OtherMABC
MANP9928OtherMABC
MAP13625Medicare UPIN