Provider Demographics
NPI:1134842677
Name:EATON, BRENNA CHANELL (RN)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:CHANELL
Last Name:EATON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:CHANELL
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4041 S MCCLINTOCK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2190 KNOWLTON ST
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1344
Practice Address - Country:US
Practice Address - Phone:520-255-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN214858163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health