Provider Demographics
NPI:1699028936
Name:BRENNAN, KERRY ANN (CPNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5802
Mailing Address - Country:US
Mailing Address - Phone:630-420-4275
Mailing Address - Fax:630-420-8957
Practice Address - Street 1:4043 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5802
Practice Address - Country:US
Practice Address - Phone:630-420-4275
Practice Address - Fax:630-420-8957
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009911363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209009911OtherAPN LICENSE