Healthcare Provider Details

I. General information

NPI: 1982760989
Provider Name (Legal Business Name): RACHEL CHRISTINE BRENNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CONWAY DR STE 200
KALISPELL MT
59901-3153
US

IV. Provider business mailing address

4717 OAK RD
ARLINGTON TN
38002-9742
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-7490
  • Fax: 406-758-7080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number43751
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMED-PHYS-LIC-112707
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP20019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: