Provider Demographics
NPI:1821151762
Name:BRECKENRIDGE, DEBBIE A (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:A
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:ENTIAT
Mailing Address - State:WA
Mailing Address - Zip Code:98822-0371
Mailing Address - Country:US
Mailing Address - Phone:509-679-7236
Mailing Address - Fax:509-784-8209
Practice Address - Street 1:607 S MISSION ST
Practice Address - Street 2:DOWNSTAIRS LOCATION
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6147
Practice Address - Country:US
Practice Address - Phone:509-679-7236
Practice Address - Fax:509-784-8209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist