Provider Demographics
NPI:1235753609
Name:BRENNAN, CAITLIN RENEE SUE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RENEE SUE
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 1:4561 STATE ROUTE 276
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2109
Mailing Address - Country:US
Mailing Address - Phone:937-469-1726
Mailing Address - Fax:
Practice Address - Street 1:2626 UPPER 5 MILE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9607
Practice Address - Country:US
Practice Address - Phone:513-508-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide