Provider Demographics
NPI:1598358087
Name:BEVAN, BREANA LYNN (MSN, CRNP, FNP -C)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:LYNN
Last Name:BEVAN
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1811
Mailing Address - Country:US
Mailing Address - Phone:267-441-0618
Mailing Address - Fax:
Practice Address - Street 1:770 NEWTOWN YARDLEY RD STE 220A
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4515
Practice Address - Country:US
Practice Address - Phone:215-486-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily