Brendan Wadlow

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

Practice address

14185 W Falcon St
Luke AFB, AZ 85309-1601

Phone

(928) 232-0764

NPI assigned

Jun 5, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marjorie Nolan Cohn LLC

  • Registered Dietitian
  • New York, NY
  • NPI 1760825160
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1063106821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14185 W FALCON ST",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "853091601",
            "telephone_number": "928-232-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14185 W FALCON ST",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "853091601",
            "telephone_number": "928-232-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADLOW",
        "first_name": "BRENDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Umesh Kumar Tiwari, MD
• Megan Tran, PHARMD
• Cheng Chung Tsai, R.PH
• Ralph Edward Umali, DDS
• United States Air Force
• Joseph Gerard Weaver, BS PHARMACY
• Kimberly A Whipple, PHARMD
• Richard Allan Williams, MD
• Monte Scott Wilson
• Robert Wilson, DO

• Pediatric Nutrition Registered Dietitian in Luke AFB, AZ
• Providers in Luke AFB, AZ by specialty
• Pediatric Nutrition Registered Dietitian in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.