Provider Demographics
NPI:1083737589
Name:GREEN, BRENNA RAE ELLWEIN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:RAE ELLWEIN
Last Name:GREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-867-7971
Mailing Address - Fax:615-867-7974
Practice Address - Street 1:1272 GARRISON DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2598
Practice Address - Country:US
Practice Address - Phone:615-867-7971
Practice Address - Fax:615-867-7974
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO02243208100000X
MI5101015750208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031729221Medicare PIN
NCP03870006Medicare UPIN