Healthcare Provider Details

I. General information

NPI: 1366846305
Provider Name (Legal Business Name): ANNE BRENNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 20TH ST APT 3A
NEW YORK NY
10009-1342
US

IV. Provider business mailing address

530 E 20TH ST APT 3A
NEW YORK NY
10009-1342
US

V. Phone/Fax

Practice location:
  • Phone: 804-317-9969
  • Fax: 949-909-8013
Mailing address:
  • Phone: 804-317-9969
  • Fax: 949-909-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172105
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: