Provider Demographics
NPI:1568953560
Name:SHATSWELL, BRENNA (FNP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:SHATSWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-6900
Mailing Address - Country:US
Mailing Address - Phone:888-380-0988
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:10251 VISTA SORRENTO PKWY STE 280
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3776
Practice Address - Country:US
Practice Address - Phone:888-380-0988
Practice Address - Fax:289-236-3022
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily