Provider Demographics
NPI:1174923882
Name:BRECKENRIDGE, MICHELLE (PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18488
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-0488
Mailing Address - Country:US
Mailing Address - Phone:720-422-6784
Mailing Address - Fax:
Practice Address - Street 1:2810 GRAPE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2730
Practice Address - Country:US
Practice Address - Phone:720-422-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist