Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2010031567 | MO |
NPI | 1093022246 |
---|---|
Provider Name | Mrs. Elizabeth Ann Brennan |
First Address | Des Peres, MO 63131-4219 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 11/11/2020 |