Healthcare Provider Details

I. General information

NPI: 1902771934
Provider Name (Legal Business Name): COURTNEY BRUTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOZER RD STE 202
BEVERLY MA
01915-5514
US

IV. Provider business mailing address

17 CENTRAL ST APT 2
BEVERLY MA
01915-5801
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2328202
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: