Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 17216 | CA |
NPI | 1750329645 |
---|---|
Provider Name | Maureen Breese |
First Address | Hayfork, CA 96041-0220 |
Second Address | Chico, CA 95973-0258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 12/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q32806 | (02) | CA |