Provider Demographics
NPI:1679143267
Name:EBRIGHT, BREANNA MARIE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:EBRIGHT
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 1:476 HALLOWING RUN RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-5632
Mailing Address - Country:US
Mailing Address - Phone:570-506-5391
Mailing Address - Fax:
Practice Address - Street 1:1190 MAPLE STREET ZINK HALL
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15705-0001
Practice Address - Country:US
Practice Address - Phone:724-357-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
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