Provider Demographics
NPI:1497517023
Name:EADIE, BRENNA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:ANNE
Last Name:EADIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2357
Mailing Address - Country:US
Mailing Address - Phone:610-500-0400
Mailing Address - Fax:
Practice Address - Street 1:1132 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3014
Practice Address - Country:US
Practice Address - Phone:856-848-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant