Provider Demographics
NPI:1952304453
Name:BRENNAN, CHRISTINE SHEEHAN (NP, CR)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:SHEEHAN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:NP, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 COLBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2240
Mailing Address - Country:US
Mailing Address - Phone:504-488-5338
Mailing Address - Fax:
Practice Address - Street 1:136 S ROMAN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3095
Practice Address - Country:US
Practice Address - Phone:504-599-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63834-1901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1550485Medicaid
5X712Medicare ID - Type Unspecified
LA1550485Medicaid