Provider Demographics
NPI:1548224181
Name:BRENNAN, NATE AARON (DPM)
Entity Type:Individual
Prefix:MR
First Name:NATE
Middle Name:AARON
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18859 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6000
Mailing Address - Country:US
Mailing Address - Phone:423-286-7850
Mailing Address - Fax:800-930-7408
Practice Address - Street 1:18859 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:800-930-7435
Practice Address - Fax:800-930-7408
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM627213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712005Medicaid
TN3712005Medicaid
V00062Medicare UPIN