Healthcare Provider Details

I. General information

NPI: 1598016644
Provider Name (Legal Business Name): BRENNA ROOHR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST STE 202B
MONROE CT
06468
US

IV. Provider business mailing address

324 ELM ST STE 202B
MONROE CT
06468-2284
US

V. Phone/Fax

Practice location:
  • Phone: 203-212-4432
  • Fax: 203-907-1234
Mailing address:
  • Phone: 203-212-4432
  • Fax: 203-907-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number005141
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number005141
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: