Healthcare Provider Details

I. General information

NPI: 1225601305
Provider Name (Legal Business Name): BRITTANY PENGEROTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST WYMAN G
CAMBRIDGE MA
02138-5597
US

IV. Provider business mailing address

330 MOUNT AUBURN ST PARSONS 2
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5639
  • Fax:
Mailing address:
  • Phone: 617-499-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2331150
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2331150
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: