Provider Demographics
NPI:1275057408
Name:BREITZMAN, AMBER MARIAN (APN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIAN
Last Name:BREITZMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 N KNOXVILLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2086
Mailing Address - Country:US
Mailing Address - Phone:309-683-0680
Mailing Address - Fax:309-692-9055
Practice Address - Street 1:7309 N KNOXVILLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2086
Practice Address - Country:US
Practice Address - Phone:309-683-0680
Practice Address - Fax:309-692-9055
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016204363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner