Provider Information for 1104268812
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ANDREA BRANT
Sex: Female
NPI: 1104268812
Last Updated: 2013-07-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1104268812 | ||||||||
| Enumeration Date | 2013-07-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 77B WARREN ST BRIGHTON, MA 02135-3601 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 77B WARREN ST BRIGHTON, MA 02135-3601 United States Phone: 617-787-1901 | Fax:617-254-3461 | ||||||||
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