Provider Demographics
NPI:1689456808
Name:CALDWELL, BREANA VICTORIA
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:VICTORIA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3529
Mailing Address - Country:US
Mailing Address - Phone:440-789-5533
Mailing Address - Fax:
Practice Address - Street 1:525 FURNACE ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3529
Practice Address - Country:US
Practice Address - Phone:440-789-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker