Provider Demographics
NPI:1366834293
Name:BREEDLOVE, PAMELA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2274
Mailing Address - Country:US
Mailing Address - Phone:317-963-1300
Mailing Address - Fax:317-222-2012
Practice Address - Street 1:355 W 16TH ST STE 5100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-963-1300
Practice Address - Fax:317-222-2012
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28155886A163W00000X
IN71005732A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201345730Medicaid