Healthcare Provider Details

I. General information

NPI: 1285832972
Provider Name (Legal Business Name): LAURA JEAN BRENNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 46TH ST
SUNNYSIDE NY
11104-1408
US

IV. Provider business mailing address

3936 46TH ST
SUNNYSIDE NY
11104-1408
US

V. Phone/Fax

Practice location:
  • Phone: 646-641-8348
  • Fax:
Mailing address:
  • Phone: 646-641-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334951
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: