Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 44376 | KS |
NPI | 1619979440 |
---|---|
Provider Name | Mrs. Brenda S Brennan |
First Address | Pittsburg, KS 66762-1832 |
Second Address | Pittsburg, KS 66762-2546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S11401 | (02) | KS |