Provider Demographics
NPI:1639420052
Name:BRENNAN, KRISTIN E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:E
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5310
Mailing Address - Country:US
Mailing Address - Phone:207-415-8388
Mailing Address - Fax:
Practice Address - Street 1:240 US ROUTE 1
Practice Address - Street 2:REJUVENATIONS MEDI SPA
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1367
Practice Address - Country:US
Practice Address - Phone:207-781-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1401175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath