Provider Demographics
NPI:1730775966
Name:BRENNAN, PAIGE (APRN)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6805
Mailing Address - Country:US
Mailing Address - Phone:618-512-1919
Mailing Address - Fax:618-512-1920
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:618-512-1919
Practice Address - Fax:618-512-1920
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily