=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518768456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOREN NICOLE BRENNAN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 STERLING DR
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-677-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4338 NANCY CT
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-6545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 312244
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------