Healthcare Provider Details

I. General information

NPI: 1487104162
Provider Name (Legal Business Name): KATLYNE BRUTUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 WASHINGTON ST
STOUGHTON MA
02072-1763
US

IV. Provider business mailing address

25 BRAINTREE HILL OFFICE PARK STE 200
BRAINTREE MA
02184-8796
US

V. Phone/Fax

Practice location:
  • Phone: 781-341-2800
  • Fax:
Mailing address:
  • Phone: 781-236-3645
  • Fax: 781-843-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2306481
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2306481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: