Individual
MR. BRENNEN PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-5850
Mailing address
1850 S PELICAN AVE, MERIDIAN, ID 83642-4747
(208) 794-2175
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
73136
ID
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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