Provider Demographics
NPI:1528227808
Name:BREESE, YVONNE M (LPN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:BREESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ELDERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2615
Mailing Address - Country:US
Mailing Address - Phone:585-305-0272
Mailing Address - Fax:
Practice Address - Street 1:44 ELDERBERRY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2615
Practice Address - Country:US
Practice Address - Phone:585-305-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291110164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02983195Medicaid