Provider Demographics
NPI:1700370681
Name:BRENNAN, KRISTIN
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MARLBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-2832
Mailing Address - Country:US
Mailing Address - Phone:915-208-2803
Mailing Address - Fax:
Practice Address - Street 1:150 MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3131
Practice Address - Country:US
Practice Address - Phone:413-256-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MA17080012175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No176B00000XOther Service ProvidersMidwife