Provider Demographics
NPI:1447956313
Name:BRENNAN, AMANDA (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 GONIC RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03839-5689
Mailing Address - Country:US
Mailing Address - Phone:603-802-3953
Mailing Address - Fax:603-803-5511
Practice Address - Street 1:323 GONIC RD STE 2A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03839-5689
Practice Address - Country:US
Practice Address - Phone:603-802-3953
Practice Address - Fax:603-803-5511
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053618-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health