Provider Demographics
NPI:1568952489
Name:CARLSON, BREANNE RENE (MS, CSCS, CPT, USAW)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:RENE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS, CSCS, CPT, USAW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N BASIN DR
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9691
Mailing Address - Country:US
Mailing Address - Phone:715-330-9399
Mailing Address - Fax:
Practice Address - Street 1:151 N BASIN DR
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9691
Practice Address - Country:US
Practice Address - Phone:715-330-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator