Provider Demographics
NPI:1639658800
Name:BRENNEMAN, AMANDA LYN (ARNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYN
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 190TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-8060
Mailing Address - Country:US
Mailing Address - Phone:319-465-5916
Mailing Address - Fax:319-465-5919
Practice Address - Street 1:12007 190TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-8060
Practice Address - Country:US
Practice Address - Phone:319-465-5916
Practice Address - Fax:319-465-5919
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA115617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily