Provider Demographics
NPI:1396151163
Name:BRENNER, LISA (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2135
Mailing Address - Country:US
Mailing Address - Phone:610-896-4466
Mailing Address - Fax:
Practice Address - Street 1:1220 VALLEY FORGE RD STE 35
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2676
Practice Address - Country:US
Practice Address - Phone:610-933-1688
Practice Address - Fax:610-983-0698
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily