Provider Demographics
NPI:1235708975
Name:HESSELTINE, BREANNE ALYSSA (PA-C)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:ALYSSA
Last Name:HESSELTINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:267 W HILLCREST DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4211
Practice Address - Country:US
Practice Address - Phone:805-497-1694
Practice Address - Fax:805-373-7493
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA63211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant