Provider Demographics
NPI:1689287971
Name:BREDBENNER, MICHELLE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:BREDBENNER
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 1:701 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-1728
Mailing Address - Country:US
Mailing Address - Phone:610-704-6080
Mailing Address - Fax:
Practice Address - Street 1:701 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-1728
Practice Address - Country:US
Practice Address - Phone:610-704-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide