Individual
BRENT MEDEIROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1030 PRESIDENT AVE RM 304, FALL RIVER, MA 02720-5923
(508) 235-6427
(508) 235-6654
Mailing address
226 BECKWITH ST, CRANSTON, RI 02910-1851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN02417
RI
363L00000X
Nurse Practitioner
Primary
RN2293550
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN02417
APRN LICENSE
RI
01
—
RN2293550
APRN LICENSE
MA
Enumeration date
10/05/2020
Last updated
10/19/2020
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