Provider Demographics
NPI:1275073652
Name:HYNES, BRENNA A
Entity Type:Individual
Prefix:MISS
First Name:BRENNA
Middle Name:A
Last Name:HYNES
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 1:2207 WALNUT ST APT 3M
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4355
Mailing Address - Country:US
Mailing Address - Phone:908-670-1983
Mailing Address - Fax:
Practice Address - Street 1:3550 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3329
Practice Address - Country:US
Practice Address - Phone:267-426-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJH96670966160954106S00000X
PASP028884363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician