Provider Demographics
NPI:1558381467
Name:BREEN, DONNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:BREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 DR CHILDRESS DR
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-0100
Mailing Address - Country:US
Mailing Address - Phone:318-253-7540
Mailing Address - Fax:318-253-7514
Practice Address - Street 1:198 DR CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-0100
Practice Address - Country:US
Practice Address - Phone:318-253-7540
Practice Address - Fax:318-253-7514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1381519Medicaid
LA1381519Medicaid
LAD87009Medicare UPIN