Provider Demographics
NPI:1467472936
Name:BRECKENRIDGE, TONETTE L (CNA)
Entity Type:Individual
Prefix:MISS
First Name:TONETTE
Middle Name:L
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MISS
Other - First Name:TONETTE
Other - Middle Name:L
Other - Last Name:BRECKENRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2907 FORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1741
Mailing Address - Country:US
Mailing Address - Phone:402-884-4753
Mailing Address - Fax:
Practice Address - Street 1:2907 FORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1741
Practice Address - Country:US
Practice Address - Phone:402-884-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51885170100000X
IAD112503376K00000X
NE376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide