Provider Demographics
NPI:1508329525
Name:BRENNAN, MEGAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:THIELEMIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 BLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4001
Mailing Address - Country:US
Mailing Address - Phone:636-358-6546
Mailing Address - Fax:
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123776207L00000X
MO2019012309367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology