MEDICARE: BRIDGET MARIE BROCKWAY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN237935	MA
2	363L00000X	Nurse Practitioner	RN237935	MA

General Provider Information

NPI Number	:	1659840825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET MARIE BROCKWAY FNP-BC

Provider Business Mailing Address
First Line	:	100 CAMBRIDGE ST FL 14
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2509
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 ROUTE 9
Second Line	:
City	:	WINDSOR
State	:	MA
Zip	:	01270-9617
Country	:	US
Telephone Number	:	413-441-5749
Fax Number	:	848-213-0264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2018
Last Update Date	:	06/18/2025

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