Provider Demographics
NPI:1184943102
Name:BRENNESSEL, KATHLEEN A (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:BRENNESSEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 KARENLEE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5401
Mailing Address - Country:US
Mailing Address - Phone:585-427-0424
Mailing Address - Fax:
Practice Address - Street 1:2180 EMPIRE BLVD
Practice Address - Street 2:VISITING NURSE SERVICE SIGNATURE CARE
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9921
Practice Address - Country:US
Practice Address - Phone:585-787-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221546163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse