Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 381481 | NY |
NPI | 1003914722 |
---|---|
Provider Name | Dawn Brennan |
First Address | Rochester, NY 14621-3001 |
Second Address | Rochester, NY 14621-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q68907 | (02) | NY |