Provider Demographics
NPI:1366181380
Name:BRENNAN, BRANDIE L
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:L
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 OLD TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-3344
Mailing Address - Country:US
Mailing Address - Phone:570-550-1092
Mailing Address - Fax:
Practice Address - Street 1:328 OLD TAVERN RD
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-3344
Practice Address - Country:US
Practice Address - Phone:570-550-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty