Provider Demographics
NPI:1861485872
Name:BRENNAN, MARY E (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7154
Mailing Address - Country:US
Mailing Address - Phone:360-414-2000
Mailing Address - Fax:
Practice Address - Street 1:1405 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2326
Practice Address - Country:US
Practice Address - Phone:360-414-2332
Practice Address - Fax:360-414-2330
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00061070163W00000X, 163WX0106X
WAAP30001951363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100229Medicaid
WA166678OtherLABOR & IND.
WA8933453OtherCRIME VICTIMS
WA9636150Medicaid
WA8933453OtherCRIME VICTIMS
OR100229Medicaid