Provider Demographics
NPI:1801300017
Name:FOX, BRENNA E (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:E
Last Name:FOX
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 SOUTHWESTERN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1231
Mailing Address - Country:US
Mailing Address - Phone:716-903-6036
Mailing Address - Fax:716-463-2225
Practice Address - Street 1:3055 SOUTHWESTERN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1231
Practice Address - Country:US
Practice Address - Phone:716-903-6036
Practice Address - Fax:716-463-2225
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696089163W00000X
NY402569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse