Healthcare Provider Details

I. General information

NPI: 1194241612
Provider Name (Legal Business Name): BRENNEN MALPASS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 CLARK HILL RD
WILMINGTON NC
28412-3459
US

IV. Provider business mailing address

7625 CLARK HILL RD
WILMINGTON NC
28412-3459
US

V. Phone/Fax

Practice location:
  • Phone: 910-512-3203
  • Fax:
Mailing address:
  • Phone: 910-512-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: