Provider Demographics
NPI:1497346688
Name:HOMER, BREANNA (RN)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 GALLANT FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2309
Mailing Address - Country:US
Mailing Address - Phone:979-997-1604
Mailing Address - Fax:
Practice Address - Street 1:2424 WILCREST DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2772
Practice Address - Country:US
Practice Address - Phone:713-666-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002834163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical