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General NPI Number Information
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NPI Number | 1194904532
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Entity Type | Individual
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Provider Name | BRANDY AULT PETERSEN RN, MSN, ANP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 180 GEORGE WASHINGTON BLVD
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City | HULL
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State | MA
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Zip | 02045-3069
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Country | US
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Telephone | 617-376-3000
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Fax | 617-774-1906
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Provider Business Mailing Address
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Address Line | 110 W SQUANTUM ST
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City | NORTH QUINCY
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State | MA
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Zip | 02171-2122
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Country | US
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Telephone | 617-376-3000
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Fax | 617-774-1906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 262850
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License Number State | MA
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