Provider Demographics
NPI:1881325926
Name:WALDEN, BREANNA (IWLC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:IWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W HAYDN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7080
Mailing Address - Country:US
Mailing Address - Phone:317-854-6597
Mailing Address - Fax:
Practice Address - Street 1:13683 STANFORD DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-8448
Practice Address - Country:US
Practice Address - Phone:317-854-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach