Provider Demographics
NPI:1407219637
Name:HADLEY, BRENNAN LORAINE
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:LORAINE
Last Name:HADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 PRAIRIE VIEW CIR
Mailing Address - Street 2:APT G
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8612
Mailing Address - Country:US
Mailing Address - Phone:317-242-9649
Mailing Address - Fax:
Practice Address - Street 1:3505 PRAIRIE VIEW CIR
Practice Address - Street 2:APT G
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-8612
Practice Address - Country:US
Practice Address - Phone:317-242-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer