Provider Demographics
NPI:1023266988
Name:LASORSA, BRENDA J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:LASORSA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:MEMORIAL CCU
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:508-334-5416
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2020-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA263033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110080352AMedicaid