Provider Demographics
NPI:1598016644
Name:ROOHR, BRENNA (APRN)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:ROOHR
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 1:324 ELM ST STE 202B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2284
Mailing Address - Country:US
Mailing Address - Phone:203-212-4432
Mailing Address - Fax:203-907-1234
Practice Address - Street 1:324 ELM ST STE 202B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:203-212-4432
Practice Address - Fax:203-907-1234
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005141363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner