1871168195 NPI number — BRIANNA VIRGINIA JEANETTE HADDEN

Table of content: BRIANNA VIRGINIA JEANETTE HADDEN (NPI 1871168195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871168195 NPI number — BRIANNA VIRGINIA JEANETTE HADDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDEN
Provider First Name:
BRIANNA
Provider Middle Name:
VIRGINIA JEANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871168195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FOULKSTONE PLAZA 1405 FOULK ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WILIMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-457-6779
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FOULKSTONE PLAZA 1405 FOULK ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WILIMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-441-3151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-20-44560 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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