Provider Demographics
NPI:1700420007
Name:BREINHOLT, DEBORAH LYNNE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNNE
Last Name:BREINHOLT
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 1:145 N CARBON AVE
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2464
Mailing Address - Country:US
Mailing Address - Phone:435-636-8441
Mailing Address - Fax:435-613-8040
Practice Address - Street 1:145 N CARBON AVE
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2464
Practice Address - Country:US
Practice Address - Phone:435-636-8441
Practice Address - Fax:435-613-8040
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator