Wade Matthew Brennan
Individual provider Active NPI Community Health Worker · Douglas, WY
NPI 1780962001 · NPPES record last updated Aug 3, 2011
Key facts
- NPI
- 1780962001
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 1841 Madora Ave
Douglas, WY 82633-3057 - Phone
- (307) 358-2846
- NPI assigned
- Aug 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
1841 Madora Ave
Douglas, WY 82633-3057
Mailing address
1841 Madora Ave
Douglas, WY 82633-3057
Other providers in Douglas, WY
- Andrea Bluel
- Courtney Bock
- Sarah Boner
- Jacqueline M Bowen
- Amanda Makenzie Bratton
- Markie Briggs
- Joanne E Brown-Vossler
- Christine M Brown
- Kirsten Brown
- Matthew Buchhammer
All providers in Douglas, WY · Community Health Worker in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.