Healthcare Provider Details

I. General information

NPI: 1982309829
Provider Name (Legal Business Name): KRISTEN ASHLEY BRENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S VALLEY FORGE RD
LANSDALE PA
19446-4242
US

IV. Provider business mailing address

1980 S EASTON RD STE 130
DOYLESTOWN PA
18901-7103
US

V. Phone/Fax

Practice location:
  • Phone: 215-362-6303
  • Fax:
Mailing address:
  • Phone: 215-600-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022137918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: