Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101023454 | MI |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101025643 | MI |
N | 207Q00000X | Family Doctor | 5101023454 | MI |
NPI | 1164942843 |
---|---|
Provider Name | Brittany Renee Breitzke |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-6804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 07/06/2021 |