Provider Demographics
NPI:1114349784
Name:CHAMOFF, BREANNA (CPNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CHAMOFF
Suffix:
Gender:F
Credentials:CPNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 S WOODLANDS VILLAGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2955
Mailing Address - Country:US
Mailing Address - Phone:785-817-3642
Mailing Address - Fax:
Practice Address - Street 1:300 E PAPAGO DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005
Practice Address - Country:US
Practice Address - Phone:928-504-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5292363LP0200X, 363LP0222X, 363LP0808X
HI2110363LP0222X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care