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General NPI Number Information
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NPI Number | 1366779571
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Entity Type | Organization
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Legal Business Name | JENNIFER MINNICK BRENNAN, APRN, BC LLC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 621 SHREWSBURY AVE
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4153
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Country | US
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Telephone | 732-741-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 211 BEECHWOOD DR
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4467
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Country | US
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Telephone | 732-546-6216
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JENNIFER MINNICK BRENNAN
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Credential | APRN, BC
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Telephone | 732-546-6216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NC10476600
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License Number State | NJ
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