Provider Demographics
NPI:1659592772
Name:DANNER, BRENDA JEANNE (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEANNE
Last Name:DANNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:JEANNE
Other - Last Name:HAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1001 HADLEY RD # LL100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1883
Practice Address - Country:US
Practice Address - Phone:317-834-9806
Practice Address - Fax:317-865-5321
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000661A133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered