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General NPI Number Information
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NPI Number | 1497517023
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Entity Type | Individual
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Provider Name | BRENNA ANNE EADIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 1132 COOPER ST
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City | DEPTFORD
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State | NJ
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Zip | 08096-3014
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Country | US
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Telephone | 856-848-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 505 HILLSIDE DR
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City | WEST CHESTER
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State | PA
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Zip | 19380-2357
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Country | US
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Telephone | 610-500-0400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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