Healthcare Provider Details

I. General information

NPI: 1942817689
Provider Name (Legal Business Name): BRENNA GRACE MAYNARD-WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENNA GRACE MAYNARD NP

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PLEASANT ST
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

87 FATIMA DR
BRISTOL RI
02809-4738
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3292
  • Fax:
Mailing address:
  • Phone: 401-575-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2308899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: