Healthcare Provider Details

I. General information

NPI: 1679516322
Provider Name (Legal Business Name): SANDRA K BRENNAN RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 AIRPORT ROAD
LINCOLN ME
04457
US

IV. Provider business mailing address

29 FRANKLIN ST
BANGOR ME
04401-4909
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-9073
  • Fax: 207-794-8919
Mailing address:
  • Phone: 207-942-3816
  • Fax: 207-561-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR034474
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: