Provider Demographics
NPI:1952749806
Name:BRENNAN-SPOTTS, MARYANNE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:ELIZABETH
Last Name:BRENNAN-SPOTTS
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 1:58 WEST OAK STREET
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-818-4882
Mailing Address - Fax:
Practice Address - Street 1:58 W OAK ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2221
Practice Address - Country:US
Practice Address - Phone:201-818-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0081031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily