Healthcare Provider Details

I. General information

NPI: 1578080909
Provider Name (Legal Business Name): ELLEN FRANCES BRADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PUTNAM PIKE
SMITHFIELD RI
02917
US

IV. Provider business mailing address

159 WESTCOTT RD
NORTH SCITUATE RI
02857-1751
US

V. Phone/Fax

Practice location:
  • Phone: 401-757-6160
  • Fax: 401-349-0840
Mailing address:
  • Phone: 401-241-5578
  • Fax: 401-398-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01670
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: