Healthcare Provider Details

I. General information

NPI: 1508402447
Provider Name (Legal Business Name): CECILIA BRENNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CE CE BRENNER RN

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

PO BOX 2495
SITKA AK
99835-2495
US

V. Phone/Fax

Practice location:
  • Phone: 907-796-8943
  • Fax:
Mailing address:
  • Phone: 907-723-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberNURR24172
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: