MEDICARE: TERRY 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	363LF0000X	Family Nurse Practitioner		IL

General Provider Information

NPI Number	:	1356417026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY BRENNAN

Provider Business Mailing Address
First Line	:	161 WASHINGTON ST
Second Line	:	EIGHT TOWER BRIDGE, SUITE 1400
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2083
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:	610-862-1547

Provider Business Practice Location Address
First Line	:	930 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:	610-862-1547

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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Directions to “ TERRY BRENNAN ” Practice Location

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