Healthcare Provider Details

I. General information

NPI: 1033029285
Provider Name (Legal Business Name): ANNABELLE BRENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1099
US

IV. Provider business mailing address

479 WASHINGTON ST
BRIGHTON MA
02135-2643
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN96801
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: