Provider Demographics
NPI:1558534180
Name:BRECKENRIDGE, BARBARA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NA
Mailing Address - Street 1:1879 WATERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3334
Mailing Address - Country:US
Mailing Address - Phone:614-238-3304
Mailing Address - Fax:
Practice Address - Street 1:1879 WATERBROOK LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3334
Practice Address - Country:US
Practice Address - Phone:614-238-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH055585164W00000X
OHPN055585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135942Medicaid