Healthcare Provider Details

I. General information

NPI: 1235209966
Provider Name (Legal Business Name): TERESA LUCENTE BRININGER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 KANSAS ST
NATICK MA
01760-2642
US

IV. Provider business mailing address

42 KANSAS ST
NATICK MA
01760-2642
US

V. Phone/Fax

Practice location:
  • Phone: 508-233-4837
  • Fax:
Mailing address:
  • Phone: 508-233-4837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberOC009257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: