Healthcare Provider Details

I. General information

NPI: 1043737711
Provider Name (Legal Business Name): BRIANNE WHITLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

71 FRANKLIN RD
HANOVER MA
02339-1825
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3800
  • Fax: 617-632-1930
Mailing address:
  • Phone: 781-635-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2312306
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2312306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: