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General NPI Number Information
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NPI Number | 1710373113
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Entity Type | Individual
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Provider Name | KATHLEEN BRENNAN DNP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 25 4TH ST NW
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City | PULASKI
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State | VA
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Zip | 24301-4613
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Country | US
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Telephone | 540-980-0922
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Fax | 650-980-2931
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Provider Business Mailing Address
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Address Line | 25 4TH ST NW PO BOX 1088
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City | PULASKI
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State | VA
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Zip | 24301
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Country | US
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Telephone | 540-980-0922
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Fax | 540-980-2931
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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 | 0024172498
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License Number State | VA
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