Individual
COLBY BRAY FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
354 TREMONT ST, BOSTON, MA 02116-5538
(617) 426-9200
(617) 426-9201
Mailing address
354 TREMONT ST, BOSTON, MA 02116-5538
(617) 429-9200
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN2325154
MA
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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