=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972771467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA LOUD NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 YARMOUTH RD
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-3064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-778-8818
-----------------------------------------------------
Fax | 508-778-1003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARDIOVASCULAR CONSULTANTS OF CAPE COD LLC 140 YARMOUTH ROAD
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-778-8818
-----------------------------------------------------
Fax | 507-778-1003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 150670
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------