Provider Demographics
NPI:1093843609
Name:SMITH, BRENDA JEANNE (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JEANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:104 TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1464
Mailing Address - Country:US
Mailing Address - Phone:978-203-6798
Mailing Address - Fax:978-416-7887
Practice Address - Street 1:104 TEMPLE DR
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1464
Practice Address - Country:US
Practice Address - Phone:978-203-6798
Practice Address - Fax:978-416-7887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706078OtherM.H. PROVIDER NUMBER