Provider Demographics
NPI:1396383634
Name:BARTLETT, BREEKYA LYNNA SAVAN
Entity Type:Individual
Prefix:
First Name:BREEKYA
Middle Name:LYNNA SAVAN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SHELBURNE RD APT C
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4982
Mailing Address - Country:US
Mailing Address - Phone:802-777-3211
Mailing Address - Fax:
Practice Address - Street 1:5897 SPEAR ST
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6579
Practice Address - Country:US
Practice Address - Phone:802-316-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0134787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse