Healthcare Provider Details

I. General information

NPI: 1700376274
Provider Name (Legal Business Name): BRETT PATRICK HUFF LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTHAMPTON ST
BOSTON MA
02118-4010
US

IV. Provider business mailing address

30 NORTHAMPTON ST
BOSTON MA
02118-4010
US

V. Phone/Fax

Practice location:
  • Phone: 617-433-9601
  • Fax: 617-445-6538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN96124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: