Healthcare Provider Details

I. General information

NPI: 1528536174
Provider Name (Legal Business Name): BRIANA GWALTNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASON AVE STE 120
SPRINGFIELD MA
01107-1179
US

IV. Provider business mailing address

100 WASON AVE STE 120
SPRINGFIELD MA
01107-1179
US

V. Phone/Fax

Practice location:
  • Phone: 413-241-2100
  • Fax: 413-735-1986
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14658
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2364705
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: