Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist |
NPI | 1003322595 |
---|---|
Provider Name | Mrs. Cynthia Breese |
First Address | Brentwood, TN 37027-5780 |
Second Address | Brentwood, TN 37027-5780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/02/2020 |