Provider Demographics
NPI:1447394234
Name:BRENNAN, ANDREA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:RUSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:35 PARK ST
Mailing Address - Street 2:SMILOW CANCER CENTER, GYNECOLOGIC ONCOLOGY, 1ST FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1110
Mailing Address - Country:US
Mailing Address - Phone:203-200-4176
Mailing Address - Fax:203-200-2069
Practice Address - Street 1:35 PARK ST
Practice Address - Street 2:SMILOW CANCER CENTER, GYNECOLOGIC ONCOLOGY, 1ST FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1110
Practice Address - Country:US
Practice Address - Phone:203-200-4176
Practice Address - Fax:203-200-2069
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002265363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical