Provider Demographics
NPI:1851024160
Name:MARTIN, BREANNE CHECKETTS
Entity Type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:CHECKETTS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:CHECKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:588 LONGMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2292
Mailing Address - Country:US
Mailing Address - Phone:413-535-1000
Mailing Address - Fax:
Practice Address - Street 1:588 LONGMEADOW ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2292
Practice Address - Country:US
Practice Address - Phone:413-565-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program