Provider Demographics
NPI:1023162328
Name:BRENNAN, KAREN (CRNA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DOUGLAS ST
Mailing Address - Street 2:#2
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 GLEN COVE DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4240
Practice Address - Country:US
Practice Address - Phone:207-921-8215
Practice Address - Fax:207-921-5302
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJX2509Medicare PIN