Healthcare Provider Details

I. General information

NPI: 1558419200
Provider Name (Legal Business Name): ANN M. BRENNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WELCH RD
PALO ALTO CA
94304-1511
US

IV. Provider business mailing address

770 WELCH RD
PALO ALTO CA
94304-1511
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-2568
  • Fax: 650-723-4312
Mailing address:
  • Phone: 650-498-2568
  • Fax: 650-723-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN526080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNPF8652
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3719
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: