Provider Demographics
NPI:1336472653
Name:CLINE, BREANNE R (LPN)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:R
Last Name:CLINE
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 1:1951 CHERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1620
Mailing Address - Country:US
Mailing Address - Phone:330-503-2661
Mailing Address - Fax:
Practice Address - Street 1:1951 CHERRY HILL AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1620
Practice Address - Country:US
Practice Address - Phone:330-503-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.127582IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse