Provider Demographics
NPI:1063661742
Name:BREITENBACH, BROOKE ERIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ERIN
Last Name:BREITENBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ERIN
Other - Last Name:PENWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2501 SHENANGO VALLEY FWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2536
Mailing Address - Country:US
Mailing Address - Phone:724-983-1820
Mailing Address - Fax:724-983-1822
Practice Address - Street 1:2501 SHENANGO VALLEY FWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2536
Practice Address - Country:US
Practice Address - Phone:724-983-1820
Practice Address - Fax:724-983-1822
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant