Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | LG-0000175 | DE |
NPI | 1700813755 |
---|---|
Provider Name | Bonnie L. Breeding |
First Address | Denton, MD 21629-2880 |
Second Address | Milford, DE 19963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |