Provider Demographics
NPI:1336408087
Name:BRENNAN, ROBIN MAUREEN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MAUREEN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PICO RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6717
Mailing Address - Country:US
Mailing Address - Phone:518-280-0044
Mailing Address - Fax:
Practice Address - Street 1:11 COMPUTER DR W
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1620
Practice Address - Country:US
Practice Address - Phone:518-459-6612
Practice Address - Fax:518-459-6614
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse