Healthcare Provider Details

I. General information

NPI: 1124699350
Provider Name (Legal Business Name): SHANA MARIA BRENNAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-1560
  • Fax:
Mailing address:
  • Phone: 508-747-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN67916
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2304341
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2304341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: