MEDICARE: KATIE BROUILLARD O'BRIEN NP

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	363L00000X	Nurse Practitioner	284603	MA
2	207N00000X	Dermatology Physician	284603	MA

General Provider Information

NPI Number	:	1801048921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BROUILLARD O'BRIEN NP

Provider Business Mailing Address
First Line	:	36 ADAMS STREET
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169
Country	:	US
Telephone Number	:	617-773-0711
Fax Number	:	617-376-2271

Provider Business Practice Location Address
First Line	:	255 PARK AVE STE 509
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1989
Country	:	US
Telephone Number	:	508-890-5500
Fax Number	:	508-890-5505

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	01/26/2026

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Directions to “ KATIE BROUILLARD O'BRIEN NP” Practice Location

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