Provider Demographics
NPI:1013981265
Name:BRENNEMAN, LOIS E (FNP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:E
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-353-2235
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:2550 N THUNDERBIRD CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1214
Practice Address - Country:US
Practice Address - Phone:480-353-2235
Practice Address - Fax:480-776-0025
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07554500363LF0000X
NYF335207363LF0000X
PASP009372363LF0000X
AZAP4256363LF0000X
NMCNP-02170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084685QDJMedicare ID - Type Unspecified
NJQ27090Medicare UPIN