Provider Demographics
NPI:1871718718
Name:AUCLAIRE, BRETT C (MSN NP)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:AUCLAIRE
Suffix:
Gender:F
Credentials:MSN NP
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 ALLENS AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5010
Mailing Address - Country:US
Mailing Address - Phone:603-244-8061
Mailing Address - Fax:603-948-1191
Practice Address - Street 1:40 CANDACE STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-444-0550
Practice Address - Fax:401-444-0425
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP3556Medicare PIN