Provider Demographics
NPI:1366819435
Name:BRENNAN, TAMRA LEE (NPC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:LEE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1311
Mailing Address - Country:US
Mailing Address - Phone:978-937-6460
Mailing Address - Fax:
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:PAIN MANAGEMENT CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1311
Practice Address - Country:US
Practice Address - Phone:978-937-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner