Healthcare Provider Details

I. General information

NPI: 1124016357
Provider Name (Legal Business Name): CHERI MARGO BRADY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 W CENTER ST
MANCHESTER CT
06040-4735
US

IV. Provider business mailing address

20 POWDER HILL RD
EAST LONGMEADOW MA
01028-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-649-1120
  • Fax: 860-645-8541
Mailing address:
  • Phone: 413-525-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000865
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: