Provider Demographics
NPI:1598026155
Name:ADAM, BREANN PAIGE (RN)
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:PAIGE
Last Name:ADAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:PAGE
Other - Last Name:WAARVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1970 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1702
Mailing Address - Country:US
Mailing Address - Phone:262-617-3154
Mailing Address - Fax:
Practice Address - Street 1:1970 S 84TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1702
Practice Address - Country:US
Practice Address - Phone:262-617-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI183686-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI163W00000XMedicaid