Provider Demographics
NPI:1689559270
Name:BRENNER, JOHN MICHAEL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRENNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16436-2829
Mailing Address - Country:US
Mailing Address - Phone:814-320-1563
Mailing Address - Fax:
Practice Address - Street 1:101 RODEO DR
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:PA
Practice Address - Zip Code:16436-2829
Practice Address - Country:US
Practice Address - Phone:814-320-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program