Healthcare Provider Details

I. General information

NPI: 1205114295
Provider Name (Legal Business Name): MEGHAN E. BRENNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 SW 2ND AVE
CANBY OR
97013-4152
US

IV. Provider business mailing address

6420 SW MACADAM AVE SUITE 300
PORTLAND OR
97239-3507
US

V. Phone/Fax

Practice location:
  • Phone: 503-416-4547
  • Fax: 503-416-4553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR23132100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20864
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250176NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTPAN8
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: