Provider Demographics
NPI:1407279631
Name:BREEN, JULIE (MSN, APN, NP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BREEN
Suffix:
Gender:F
Credentials:MSN, APN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3109
Mailing Address - Country:US
Mailing Address - Phone:704-376-1605
Mailing Address - Fax:704-335-8448
Practice Address - Street 1:1130 N CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1041
Practice Address - Country:US
Practice Address - Phone:362-724-5783
Practice Address - Fax:336-272-5931
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00473200363LA2200X
NC5008874363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health