Provider Demographics
NPI:1215603998
Name:LANNEN, BRETT THOMAS (RN/SRNA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:THOMAS
Last Name:LANNEN
Suffix:
Gender:M
Credentials:RN/SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BLUE FOX TRL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-7986
Mailing Address - Country:US
Mailing Address - Phone:716-574-5018
Mailing Address - Fax:
Practice Address - Street 1:106 BLUE FOX TRL
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-7986
Practice Address - Country:US
Practice Address - Phone:716-574-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN212638390200000X
TN33162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program