Healthcare Provider Details

I. General information

NPI: 1689301954
Provider Name (Legal Business Name): BRITTANY GAUTHIER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 11/12/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEMORIAL DR STE 205
LEOMINSTER MA
01453-2238
US

IV. Provider business mailing address

50 MEMORIAL DR STE 205
LEOMINSTER MA
01453-2238
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-4241
  • Fax:
Mailing address:
  • Phone: 978-534-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2301706
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022011898
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: