Healthcare Provider Details

I. General information

NPI: 1275468035
Provider Name (Legal Business Name): STEPHANIE BRENER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FAIRVIEW AVE N
SEATTLE WA
98109-4433
US

IV. Provider business mailing address

2284 GLEIM DR
ENOLA PA
17025-1849
US

V. Phone/Fax

Practice location:
  • Phone: 206-606-1209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberRN645306
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: