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General NPI Number Information
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NPI Number | 1144030040
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Entity Type | Individual
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Provider Name | BRENNA KATHLEEN TRESIDDER FNP
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 911 E 9 MILE RD
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City | FERNDALE
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State | MI
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Zip | 48220-1934
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Country | US
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Telephone | 248-336-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 18000 W 9 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4020
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Country | US
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Telephone | 248-336-4000
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704304820
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License Number State | MI
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