Healthcare Provider Details

I. General information

NPI: 1497517023
Provider Name (Legal Business Name): BRENNA ANNE EADIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 COOPER ST
DEPTFORD NJ
08096-3014
US

IV. Provider business mailing address

505 HILLSIDE DR
WEST CHESTER PA
19380-2357
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-8060
  • Fax:
Mailing address:
  • Phone: 610-500-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: