Provider Demographics
NPI:1447994736
Name:BRENNAN, CONNIE MARIE (APRN, AGNP-BC, PHN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APRN, AGNP-BC, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N ORONO ORCHARDS RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9435
Mailing Address - Country:US
Mailing Address - Phone:952-208-0031
Mailing Address - Fax:
Practice Address - Street 1:5525 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1420
Practice Address - Country:US
Practice Address - Phone:952-541-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9128363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology