Provider Demographics
NPI:1134827249
Name:BRENNAN, HALEY RENEE (MS, RDN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RENEE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 E LAKE FRONT CIR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3315
Mailing Address - Country:US
Mailing Address - Phone:609-437-4476
Mailing Address - Fax:
Practice Address - Street 1:686 E LAKE FRONT CIR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3315
Practice Address - Country:US
Practice Address - Phone:609-437-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86290569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered