Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1356672604

Unknown Individual is a healthcare provider. based in Brockton, Massachusetts. specializing in NURSE PRACTITIONER. They hold a License No. 115563 (MA). The NPI Number for Unknown Individual is 1356672604

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356672604
Phone
(508) 510-5133
Address
177 CARROLL AVE
Deactivation Date
22 October 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2009 (17 years ago)
PAC ID
5193854263
Professional Enrollment ID
I20100527000666
Address ID
MA023700000RO18XXXSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

8,972 NURSE PRACTITIONER in MA

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Provider Addresses for Unknown Individual

  • 177, Carroll Avenue, Brockton, Plymouth County, Massachusetts, 02301, United States

    BROCKTON, MA 023016315

    Phone: (508) 510-5133

    Fax: (508) 583-9800

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02301)

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Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1356672604 uniquely identifies Unknown Individual in U.S. healthcare data.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Brockton, Massachusetts?
For routing, start with Brockton, Massachusetts for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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