Provider Demographics
NPI:1639771595
Name:BRENNAMAN, BRIAN D
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BRENNAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8469
Mailing Address - Country:US
Mailing Address - Phone:937-974-2134
Mailing Address - Fax:
Practice Address - Street 1:1090 RICHARD DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2557
Practice Address - Country:US
Practice Address - Phone:937-974-2134
Practice Address - Fax:937-708-5878
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2904860376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker