Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2006004611 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2006004611 | MO |
NPI | 1841384401 |
---|---|
Provider Name | Lisa Marie Brennaman |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 22/05/2018 |