Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH11741 | FL |
NPI | 1306375456 |
---|---|
Provider Name | Kelsey Brenner |
First Address | Miami, FL 33145-2945 |
Second Address | Miami, FL 33145-2945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2017 |
Last Update Date | 11/06/2017 |