Provider Demographics
NPI:1154427037
Name:BRENNAN, SAUNDRA D (PA)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:D
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:909 N. 96TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2508
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-330-4626
Practice Address - Street 1:909 N. 96TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2508
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-330-4626
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001617363A00000X
NE1455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16634Medicare ID - Type Unspecified
NE099992003Medicare PIN
IAI15881Medicare PIN