BRENNEN LARK (NPI# 1134644305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134644305 |
| Entity Type | Individual |
| Full Name | BRENNEN LARK |
| Practice Address |
1901 Manhattan Blvd Bldg D Harvey LA 70058-3583 |
| Mailing Address |
Po Box 1414 Sagamore Beach MA 02562-1414 |
| Practice Telephone | 5043726250 |
| Practice Fax Number | 5043726301 |
| Mailing Telephone | 5044943543 |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2018-03-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 171W00000X | Contractor | LA161608 | LA | Other Service Providers |
| Y | 207KI0005X |
Allergy & Immunology Specialization: Clinical & Laboratory Immunology |
LA161608 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | OCCUPATIONAL LICENSE | LA161608 | 01 |
| Street Address |
1901 MANHATTAN BLVD BLDG D |
| City | HARVEY |
| State | LA |
| Zip Code | 70058-3583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699146522 | Morgan Lynne Wangerin | Counselor | 1901 Manhattan Blvd Bldg D, Harvey, LA 70058 | 2015-10-19 |
| 1417502113 | Motivate Wellness Behavioral & Relationship Health Services, LLC | Clinic/Center | 1901 Manhattan Blvd Bldg D, Harvey, LA 70058-3583 | 2019-08-08 |
| 1427416171 | Immunolase LLC | Allergy & Immunology | 1901 Manhattan Blvd Bldg D, Harvey, LA 70058-3583 | 2016-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144853003 | Carmen Nikita Ward-lewis | Counselor | 1901 Manhattan Blvd, Building D, Suite 104, Harvey, LA 70058 | 2020-02-19 |
| 1275023087 | Michael Ellis | Counselor | 3820 Melissa Dr, Harvey, LA 70058 | 2018-05-16 |
| 1316436447 | Affiliated Heart2heart Homecare Services, Inc. | In Home Supportive Care | 1901 Westbank Expy Ste 600, Harvey, LA 70058 | 2018-05-03 |
| 1720595804 | Alkeisha Lachelle Clark | Counselor | 4209 L Ac Couture Dr., D, Harvey, LA 70058 | 2018-01-10 |
| 1659888253 | Kevin A Velasquez | Psychologist | 81 Lake Lynn Dr, Harvey, LA 70058 | 2018-01-04 |
| 1629582937 | Tessie Hart | Counselor | 426 Manhattan Blvd., Harvey, LA 70058 | 2017-11-22 |
| 1326557562 | Lauretta Anne Gavin | Counselor | 2439 Manhattan Blvd., Suite 207, Harvey, LA 70058 | 2017-09-20 |
| 1760908792 | Eboni Dillon | Counselor | 3148 Keith Way Dr, Harvey, LA 70058 | 2017-08-22 |
| 1194246207 | Shawn Galmore | Counselor | 2808 Keithway Dr, Harvey, LA 70058 | 2017-06-28 |
| 1750811345 | Elite Learning Academy | Private Vehicle | 1913 Sugarloaf Drive, Harvey, LA 70058 | 2017-06-15 |
| Find all providers in zip 70058 | ||||
| Taxonomy Code | 207KI0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| Specialization | Clinical & Laboratory Immunology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427416171 | Immunolase LLC | Allergy & Immunology | 1901 Manhattan Blvd Bldg D, Harvey, LA 70058-3583 | 2016-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760939987 | Wk Allergy and Asthma Clinic | Allergy & Immunology | 2300 Hospital Dr Ste 345, Bossier City, LA 71111-2194 | 2016-09-06 |
| 1639597768 | Elizabeth Renee Smith | Allergy & Immunology | 101 Rue Fontaine Bldg 2, Lafayette, LA 70508-5744 | 2014-04-05 |
| 1295786192 | Manuel Lopez | Allergy & Immunology | 1514 Jefferson Hwy, New Orleans, LA 70121-2429 | 2006-05-15 |
| 1447217252 | Peter Bryan Boggs | Allergy & Immunology | 2300 Hospital Dr, Suite 110, Bossier City, LA 71111-2394 | 2006-04-26 |
| 1346232212 | Bina E Joseph | Allergy & Immunology | 320 Settlers Trace Blvd, Lafayette, LA 70508 | 2005-08-17 |
Please comment or provide details below to improve the information on BRENNEN LARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.