Provider Demographics
NPI:1649455155
Name:BRENNAN, JOANNE (RN, CPN)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOHSEEPEE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1816
Mailing Address - Country:US
Mailing Address - Phone:631-666-9029
Mailing Address - Fax:
Practice Address - Street 1:104 WOHSEEPEE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1816
Practice Address - Country:US
Practice Address - Phone:631-666-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291864-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02498240Medicaid