Healthcare Provider Details

I. General information

NPI: 1083769970
Provider Name (Legal Business Name): PATRICIA ANN BRENNAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5950
  • Fax: 617-975-0840
Mailing address:
  • Phone: 617-732-5950
  • Fax: 617-975-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number119215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: