Provider Demographics
NPI:1942817689
Name:MAYNARD-WHITE, BRENNA GRACE (NP)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:GRACE
Last Name:MAYNARD-WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:GRACE
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:87 FATIMA DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4738
Mailing Address - Country:US
Mailing Address - Phone:401-575-9974
Mailing Address - Fax:
Practice Address - Street 1:277 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-676-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily