Provider Demographics
NPI:1609218072
Name:BRENNAN, KAITLYN PATRICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PATRICIA
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:MELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 BAKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-9300
Mailing Address - Fax:978-250-3989
Practice Address - Street 1:330 BAKER AVENUE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-9300
Practice Address - Fax:978-250-3989
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily