Provider Demographics
NPI:1831448448
Name:BRENNAN, PAMELA KELLY
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KELLY
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:208 CIBOLO RIDGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015
Mailing Address - Country:US
Mailing Address - Phone:210-269-8115
Mailing Address - Fax:
Practice Address - Street 1:208 CIBOLO RIDGE TRAIL
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015
Practice Address - Country:US
Practice Address - Phone:210-269-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686650163WL0100X
VA103-20123163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant