Provider Demographics
NPI:1376961086
Name:CUMMENS, BREANA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:CHRISTINE
Last Name:CUMMENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 S. 76TH ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220
Mailing Address - Country:US
Mailing Address - Phone:414-777-3100
Mailing Address - Fax:525-260-7345
Practice Address - Street 1:4935 S. 76TH ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-777-3100
Practice Address - Fax:525-260-7345
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI64724-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program