Individual
MARY T BRENNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-2202
(860) 679-3107
(860) 679-1843
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
002561
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497855274
—
CT
Enumeration date
09/22/2006
Last updated
05/06/2013
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