Individual
LISA DONDERO BRENGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
425 REVERE ST, REVERE, MA 02151-4543
(781) 286-1313
(781) 286-1098
Mailing address
425 REVERE ST, REVERE, MA 02151-4543
(781) 286-1313
(781) 286-1098
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
215851
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0338290
—
MA
Enumeration date
10/19/2005
Last updated
04/04/2013
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