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NPI Code Detail

MEDICARE: MS. BRENDA REISS BRENNAN APRN

MEDICARE: MS. BRENDA REISS BRENNAN APRN
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
1163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse1993934405UT

General Provider Information

NPI Number : 1467523621
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRENDA REISS BRENNAN APRN
Provider Business Mailing Address
First Line : 2000 S 900 E
Second Line :
City : SLC
State : UT
Zip : 84105-3208
Country : US
Telephone Number : 801-464-7854
Fax Number : 801-464-7876
Provider Business Practice Location Address
First Line : 2000 S 900 E
Second Line :
City : SLC
State : UT
Zip : 84105-3208
Country : US
Telephone Number : 801-464-7854
Fax Number : 801-464-7876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 07/08/2007

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