Healthcare Provider Details

I. General information

NPI: 1225573900
Provider Name (Legal Business Name): EMILY BRONWYN DRAZEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 GREAT RD
ACTON MA
01720-5777
US

IV. Provider business mailing address

179 GREAT RD
ACTON MA
01720-5777
US

V. Phone/Fax

Practice location:
  • Phone: 857-229-2852
  • Fax: 857-216-6588
Mailing address:
  • Phone: 857-229-2852
  • Fax: 857-216-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269738
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: