Provider Demographics
NPI:1326393083
Name:BRENNAN, BARBARA JEAN
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA, MS
Mailing Address - Street 1:311 S MYERS PL
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2215
Mailing Address - Country:US
Mailing Address - Phone:310-308-2664
Mailing Address - Fax:
Practice Address - Street 1:311 S MYERS PL
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2215
Practice Address - Country:US
Practice Address - Phone:310-308-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA4330367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program