Basic Information
| Provider Information | |||||||||
| NPI: | 1811532724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUTUS | ||||||||
| FirstName: | YVEDA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 SHREWSBURY ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016041689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087535554 | ||||||||
| FaxNumber: | 5087527245 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 SHREWSBURY ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016041689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087535554 | ||||||||
| FaxNumber: | 5087527245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2019 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | RN2261311 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 163WP0807X | 2261311 | MA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
No ID Information.