Healthcare Provider Details

I. General information

NPI: 1043821903
Provider Name (Legal Business Name): BRENNA CHRISTIE FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MINNESOTA DR STE 510
BLOOMINGTON MN
55435-5835
US

IV. Provider business mailing address

3601 MINNESOTA DR STE 510
BLOOMINGTON MN
55435-5835
US

V. Phone/Fax

Practice location:
  • Phone: 952-592-5421
  • Fax: 952-209-6329
Mailing address:
  • Phone: 952-592-5421
  • Fax: 952-209-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9778
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0995767-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995767-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9778
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: