MEDICARE: KATHRYN NICOLE BRENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2016023420	MO

General Provider Information

NPI Number	:	1093160814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN NICOLE BRENNAN

Provider Business Mailing Address
First Line	:	10733 CHARRETTE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-3914
Country	:	US
Telephone Number	:	314-691-2874
Fax Number	:

Provider Business Practice Location Address
First Line	:	10733 CHARRETTE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-3914
Country	:	US
Telephone Number	:	314-691-2874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	08/07/2016

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Directions to “ KATHRYN NICOLE BRENNAN ” Practice Location

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