Provider Demographics
NPI:1710902614
Name:BRESLIN, MARY GORMAN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GORMAN
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GORMAN
Other - Last Name:CASSIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1 MOYER PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-4423
Mailing Address - Country:US
Mailing Address - Phone:513-321-0522
Mailing Address - Fax:
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:B729
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004326363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health