Provider Demographics
NPI:1073806923
Name:VEAL, BREANNA R (PA-C)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:R
Last Name:VEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 PARAGON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4041
Mailing Address - Country:US
Mailing Address - Phone:937-208-6920
Mailing Address - Fax:937-208-6948
Practice Address - Street 1:7707 PARAGON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4041
Practice Address - Country:US
Practice Address - Phone:937-208-6920
Practice Address - Fax:937-208-6948
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067879Medicaid
OH0067879Medicaid