Provider Demographics
NPI:1083095202
Name:BREAU, JOANNE (LPN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BREAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1362
Mailing Address - Country:US
Mailing Address - Phone:978-852-1616
Mailing Address - Fax:
Practice Address - Street 1:52 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1362
Practice Address - Country:US
Practice Address - Phone:978-852-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN67076164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse