Provider Demographics
NPI:1538103437
Name:DRENNEN, MARY K (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 NEW RD STE F1
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1053
Mailing Address - Country:US
Mailing Address - Phone:609-642-2663
Mailing Address - Fax:
Practice Address - Street 1:1418 NEW RD STE 1C
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1179
Practice Address - Country:US
Practice Address - Phone:609-699-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05109500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7472803Medicaid
NJ7472803Medicaid
NJ381020OtherGROUP MEDICARE
NJS45708Medicare UPIN
NJ002893ZK8MMedicare PIN