Healthcare Provider Details

I. General information

NPI: 1548798499
Provider Name (Legal Business Name): JANELLE NOBREGA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE ATTN: 8 EAST INPATIENT CARDIOLOGY
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number280577
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: