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General NPI Number Information
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NPI Number | 1003895426
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Entity Type | Individual
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Provider Name | CAROL B BRENNAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 475 S DOBSON RD
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City | CHANDLER
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State | AZ
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Zip | 85224-5605
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Country | US
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Telephone | 480-728-3753
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Fax | 480-728-3305
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Provider Business Mailing Address
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Address Line | 8501 S TERRACE RD
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City | TEMPE
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State | AZ
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Zip | 85284-2442
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Country | US
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Telephone | 480-768-9784
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Fax | 480-768-9785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2251
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License Number State | AZ
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