Provider Demographics
NPI:1386627156
Name:HOLLINGSWORTH-BRENNER, LINDA A (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:HOLLINGSWORTH-BRENNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1385 ROBYN CT
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3374
Mailing Address - Country:US
Mailing Address - Phone:573-302-0678
Mailing Address - Fax:573-302-7154
Practice Address - Street 1:38383 PLAINVIEW DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1438
Practice Address - Country:US
Practice Address - Phone:573-302-0678
Practice Address - Fax:573-302-7154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26296Medicare UPIN