Individual
BRIAN FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
275 SANDWICH ST, PLYMOUTH, MA 02360
(508) 746-2000
Mailing address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 746-2000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
062441-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
RN174475
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000179713
ANTHEM BLUE SHIELD
—
05
—
0810500
—
OH
05
—
200419580
—
IN
05
—
3134668
—
NH
05
—
74382060
—
KY
Enumeration date
12/05/2005
Last updated
01/04/2023
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