Provider Demographics
NPI:1780212175
Name:BRABENDER, BREANNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ELIZABETH
Last Name:BRABENDER
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 1:1211 SILVER SAGE DR APT 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3961
Mailing Address - Country:US
Mailing Address - Phone:814-460-4746
Mailing Address - Fax:
Practice Address - Street 1:4350 US 421 S
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6760
Practice Address - Country:US
Practice Address - Phone:910-893-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program