Provider Demographics
NPI:1801564646
Name:BRENNAN, LAUREN DOMENICA (RN,MSN,CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:DOMENICA
Last Name:BRENNAN
Suffix:
Gender:
Credentials:RN,MSN,CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BESTGATE RD
Mailing Address - Street 2:STE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-2118
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3404
Practice Address - Country:US
Practice Address - Phone:410-505-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2021035861363LF0000X
MDR232666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily