Provider Demographics
NPI:1598072605
Name:POMPEY, BREANNE RENEE (PA)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:RENEE
Last Name:POMPEY
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:3373 COMMERCE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7130
Mailing Address - Country:US
Mailing Address - Phone:330-804-9712
Mailing Address - Fax:330-804-9717
Practice Address - Street 1:3373 COMMERCE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7130
Practice Address - Country:US
Practice Address - Phone:330-804-9712
Practice Address - Fax:330-804-9717
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068378Medicaid
OH0068378Medicaid