Provider Demographics
NPI:1528328663
Name:HATAMI, BRENNA CELESTE (ND)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:CELESTE
Last Name:HATAMI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 YORK ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-320-1174
Mailing Address - Fax:
Practice Address - Street 1:1441 YORK ST
Practice Address - Street 2:SUITE 303
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-320-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT009.0000026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine