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General NPI Number Information
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NPI Number | 1972210805
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Entity Type | Individual
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Provider Name | BREANNA N. BADER APRN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 234 E GRAY ST STE 334
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City | LOUISVILLE
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State | KY
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Zip | 40202-1902
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Country | US
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Telephone | 502-882-9237
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Fax | 502-893-3900
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-559-9407
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Fax | 502-272-5339
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3018617
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License Number State | KY
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