Provider Demographics
NPI:1609983857
Name:BRENNAN, JOAN ELIZABETH (RNP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RNP
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Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4760
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:75 SOCKANOSSET CROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5558
Practice Address - Country:US
Practice Address - Phone:401-946-6200
Practice Address - Fax:401-275-1992
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RINPP37367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJB73279Medicaid
RI0070589051OtherMEDICARE PTAN
RI411813OtherUGS