Provider Demographics
NPI:1275322232
Name:QUENNEVILLE, BRIANNA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:QUENNEVILLE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2113 FRONT RD N
Mailing Address - Street 2:
Mailing Address - City:AMHERSTBURG
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9V 3R3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2113 FRONT RD N
Practice Address - Street 2:
Practice Address - City:AMHERSTBURG
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9V 3R3
Practice Address - Country:CA
Practice Address - Phone:519-992-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037707207Q00000X
MI4704338544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine