Provider Demographics
NPI:1174563977
Name:WOODBURY, BRENDA ISABELLA (NP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ISABELLA
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 HANOVER ST
Mailing Address - Street 2:NEHC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1901
Mailing Address - Country:US
Mailing Address - Phone:617-643-8163
Mailing Address - Fax:
Practice Address - Street 1:332 HANOVER ST
Practice Address - Street 2:NEHC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-1901
Practice Address - Country:US
Practice Address - Phone:617-643-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121171363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology