Provider Demographics
NPI:1982003109
Name:BRENNAN, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4440 W 95TH ST STE 6409
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:778-684-4327
Mailing Address - Fax:708-520-1875
Practice Address - Street 1:4440 WEST 95TH STREET
Practice Address - Street 2:SUITE 2638 OUTPT. PAVILLION
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60464
Practice Address - Country:US
Practice Address - Phone:708-684-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011414363LG0600X, 363LP2300X
IL209-011414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care