Healthcare Provider Details

I. General information

NPI: 1154879518
Provider Name (Legal Business Name): BRITTANY REGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MAIN ST
BROCKTON MA
02301-5340
US

IV. Provider business mailing address

942 W CHESTNUT ST
BROCKTON MA
02301-5567
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-3005
  • Fax:
Mailing address:
  • Phone: 508-586-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2298868
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: