Provider Demographics
NPI:1578512463
Name:BREZINE, COLLEEN M (CNM)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:BREZINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29160 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5225
Mailing Address - Country:US
Mailing Address - Phone:440-835-6996
Mailing Address - Fax:440-808-9387
Practice Address - Street 1:29160 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5225
Practice Address - Country:US
Practice Address - Phone:440-835-6996
Practice Address - Fax:440-808-9387
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03844-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2116561Medicaid
OHNM01517Medicare PIN
OH2116561Medicaid
S86897Medicare UPIN
OHBRNM01518Medicare PIN
OHNM01516Medicare PIN