Provider Demographics
NPI:1811902661
Name:DRENNAN, KATHLEEN MARIE (BSN, MSN, APRN-C)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DRENNAN
Suffix:
Gender:F
Credentials:BSN, MSN, APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3535
Mailing Address - Country:US
Mailing Address - Phone:760-295-6739
Mailing Address - Fax:
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:606-302-5507
Practice Address - Fax:760-726-2305
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16350363LF0000X
CA16350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX085ZOtherMEDICARE PTAN
CANP16350OtherCA LICENSE