Provider Demographics
NPI:1366818254
Name:BRENNEMAN, KATHLEEN RENEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RENEE
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06027-1313
Mailing Address - Country:US
Mailing Address - Phone:203-314-1690
Mailing Address - Fax:
Practice Address - Street 1:540 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6679
Practice Address - Country:US
Practice Address - Phone:860-496-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant