Provider Demographics
NPI:1184146854
Name:BRENNER, BRANDI MARIE (CNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 SHALLOWFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1202
Mailing Address - Country:US
Mailing Address - Phone:614-806-9047
Mailing Address - Fax:
Practice Address - Street 1:4191 KELNOR DR STE 300
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3990
Practice Address - Country:US
Practice Address - Phone:614-875-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.02063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily