Provider Demographics
NPI:1790799666
Name:BREED, ANNETTE LAPE (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LAPE
Last Name:BREED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S DIMOCK RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3109
Mailing Address - Country:US
Mailing Address - Phone:252-623-1157
Mailing Address - Fax:
Practice Address - Street 1:1380 COWELL FARM RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3431
Practice Address - Country:US
Practice Address - Phone:252-946-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001082157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010373450Medicaid
VA7789254Medicaid
VA7789254Medicaid
VA500018004Medicare PIN
VA010373450Medicaid
VA500000772Medicare PIN
VAP00365973Medicare PIN