MEDICARE: KIMBERLY R BRENNAN APN

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	363LP2300X	Primary Care Nurse Practitioner	26NJ01236700	NJ

General Provider Information

NPI Number	:	1326707621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R BRENNAN APN

Provider Business Mailing Address
First Line	:	7313 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1958
Country	:	US
Telephone Number	:	609-441-2199
Fax Number	:	609-822-1390

Provider Business Practice Location Address
First Line	:	7313 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1958
Country	:	US
Telephone Number	:	609-441-2199
Fax Number	:	609-822-1390

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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