Healthcare Provider Details

I. General information

NPI: 1629400734
Provider Name (Legal Business Name): BRENNAN N CARMODY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 09/29/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E CALDERWOOD DR STE 150D
MERIDIAN ID
83642-9095
US

IV. Provider business mailing address

2169 W OAKHAMPTON DR
EAGLE ID
83616-7632
US

V. Phone/Fax

Practice location:
  • Phone: 208-402-8946
  • Fax: 208-248-6939
Mailing address:
  • Phone: 208-631-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1318A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNPPEND
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: