Healthcare Provider Details

I. General information

NPI: 1609218072
Provider Name (Legal Business Name): KAITLYN PATRICIA BRENNAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MELLMAN

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BAKER AVENUE
CONCORD MA
01742
US

IV. Provider business mailing address

330 BAKER AVENUE
CONCORD MA
01742
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-9300
  • Fax: 978-250-3989
Mailing address:
  • Phone: 978-287-9300
  • Fax: 978-250-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2264159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: