Provider Demographics
NPI:1447450036
Name:BRENNAN, KATHLEEN ANN (APRN-RX, FNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APRN-RX, FNP
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2239 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2539
Mailing Address - Country:US
Mailing Address - Phone:808-791-9400
Mailing Address - Fax:808-847-6051
Practice Address - Street 1:2239 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2539
Practice Address - Country:US
Practice Address - Phone:808-791-9400
Practice Address - Fax:808-847-6051
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 463, RX 111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI001030-6OtherHMSA-2
12-1800OtherMEDICARE
HI0000992101Medicaid