Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN78846-WHNP-BC | WV |
N | 363LW0102X | Nurse Practitioner - Women's Health | HEN1-0437-9557 | WV |
NPI | 1023443215 |
---|---|
Provider Name | Ms. Breann Hawley Thomas |
First Address | Scott Depot, WV 25560-9815 |
Second Address | Scott Depot, WV 25560-9815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2013 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810027592 | (05) | WV |