Provider Demographics
NPI:1427613645
Name:WRENN, BRENDA JEAN
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:WRENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8A BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-1300
Mailing Address - Country:US
Mailing Address - Phone:860-334-1329
Mailing Address - Fax:
Practice Address - Street 1:153 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234
Practice Address - Country:US
Practice Address - Phone:860-334-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver