Provider Demographics
NPI:1538125455
Name:BRENNAN, MARIA J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CANTERBURY RD.
Mailing Address - Street 2:WINDHAM UROLOGY GROUP
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234
Mailing Address - Country:US
Mailing Address - Phone:860-412-0491
Mailing Address - Fax:860-412-0496
Practice Address - Street 1:63 CANTERBURY RD
Practice Address - Street 2:WINDHAM UROLOGY GROUP
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234
Practice Address - Country:US
Practice Address - Phone:860-412-0491
Practice Address - Fax:860-412-0496
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001754363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00419867900OtherBLUECARE FAMILY PLAN
CT500000089Medicaid
CT004198679Medicaid
CT2V4032OtherHEALTHNET OF CT
CTP2971942OtherOXFORD HEALTH PLAN
CT40000175CT01OtherANTHEM BC/BS
CT00419867900OtherBLUECARE FAMILY PLAN
CTP2971942OtherOXFORD HEALTH PLAN