Provider Demographics
NPI:1194122465
Name:EBLE, BRIANNA ROSE (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ROSE
Last Name:EBLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 THE FENWAY
Mailing Address - Street 2:HEALTH SERVICES, 210 MARIAN HALL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5725
Mailing Address - Country:US
Mailing Address - Phone:617-264-7678
Mailing Address - Fax:
Practice Address - Street 1:400 THE FENWAY
Practice Address - Street 2:HEALTH SERVICES, 210 MARIAN HALL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-264-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261806363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care