Provider Demographics
NPI:1689228967
Name:BRENNAN, KIMBERLY FRANCES (CCMA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FRANCES
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 E MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2729
Mailing Address - Country:US
Mailing Address - Phone:570-468-5778
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1762
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:570-291-4473
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD2X8X9MZ374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician