Healthcare Provider Details

I. General information

NPI: 1861485872
Provider Name (Legal Business Name): MARY E BRENNAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 DELAWARE ST
LONGVIEW WA
98632-2326
US

IV. Provider business mailing address

PO BOX 249
LONGVIEW WA
98632-7154
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2332
  • Fax: 360-414-2330
Mailing address:
  • Phone: 360-414-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00061070
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN00061070
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30001951
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP30001951
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: