Provider Demographics
NPI:1780623488
Name:BRENNAN-JORDAN, NANCY (FNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BRENNAN-JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1820
Mailing Address - Country:US
Mailing Address - Phone:609-741-0818
Mailing Address - Fax:
Practice Address - Street 1:44 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1820
Practice Address - Country:US
Practice Address - Phone:609-741-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP92761Medicare UPIN
NYDD6184Medicare ID - Type Unspecified