Provider Demographics
NPI:1134338759
Name:BRENNAN, CARRIE J (ND)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 KUKUI ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1701
Mailing Address - Country:US
Mailing Address - Phone:808-823-0994
Mailing Address - Fax:808-823-0995
Practice Address - Street 1:4504 KUKUI ST
Practice Address - Street 2:SUITE 13
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1701
Practice Address - Country:US
Practice Address - Phone:808-823-0994
Practice Address - Fax:808-823-0995
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI 150175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath