Healthcare Provider Details

I. General information

NPI: 1558696872
Provider Name (Legal Business Name): BRIANA PATRICIA MCCONNELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 10/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST STE 1
LOWELL MA
01852-1900
US

IV. Provider business mailing address

105 BROOKINGS ST
MEDFORD MA
02155-5446
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-6800
  • Fax:
Mailing address:
  • Phone: 781-393-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2261341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: