Provider Demographics
NPI:1518686542
Name:BRENNAN, SIOBHAN CLAIRE (PNP)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:CLAIRE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NEW BERN PL APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1401
Mailing Address - Country:US
Mailing Address - Phone:732-859-0837
Mailing Address - Fax:
Practice Address - Street 1:1519 E BOOKER DAIRY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9472
Practice Address - Country:US
Practice Address - Phone:919-938-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics