Provider Demographics
NPI:1508402447
Name:BRENNER, CECILIA (RN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CE CE
Other - Middle Name:
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2495
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-2495
Mailing Address - Country:US
Mailing Address - Phone:907-723-0140
Mailing Address - Fax:
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-796-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR24172163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health