Provider Demographics
NPI:1053134908
Name:BRENNAN, ELIZABETH ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 FERNBROOK LN N STE 120
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5339
Mailing Address - Country:US
Mailing Address - Phone:763-559-7050
Mailing Address - Fax:763-559-7060
Practice Address - Street 1:3300 FERNBROOK LN N STE 120
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5339
Practice Address - Country:US
Practice Address - Phone:763-559-7050
Practice Address - Fax:763-559-7060
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN12163363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health