Provider Demographics
NPI:1750329645
Name:BREESE, MAUREEN (FNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BREESE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:6961 HIGHWAY 3
Mailing Address - City:HAYFORK
Mailing Address - State:CA
Mailing Address - Zip Code:96041-0220
Mailing Address - Country:US
Mailing Address - Phone:530-628-5517
Mailing Address - Fax:530-628-5524
Practice Address - Street 1:100 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0258
Practice Address - Country:US
Practice Address - Phone:530-899-9153
Practice Address - Fax:530-899-0142
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17216363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ32806Medicare UPIN