Provider Demographics
NPI:1669725909
Name:GONYO, BRENNA
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:
Last Name:GONYO
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 1:147 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6994
Mailing Address - Country:US
Mailing Address - Phone:802-318-5492
Mailing Address - Fax:
Practice Address - Street 1:38 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4900
Practice Address - Country:US
Practice Address - Phone:802-372-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0089842164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse