Individual
ADAM BRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5192 HIGHWAY 11 N, ELLISVILLE, MS 39437-5050
(601) 649-7921
(601) 649-7939
Mailing address
PO BOX 113, LAUREL, MS 39441-0113
(601) 649-7921
(601) 649-7939
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
873749
MS
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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