| NPI | 1366741720 |
|---|---|
| Former Name | BRENNA ELIZABETH SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME150199) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 259770) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2021-08-20 |