Provider Demographics
NPI:1861628695
Name:VINSON, BREONY MILLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BREONY
Middle Name:MILLER
Last Name:VINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3505 CONVERSE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6131
Mailing Address - Country:US
Mailing Address - Phone:910-392-5634
Mailing Address - Fax:910-392-5654
Practice Address - Street 1:3505 CONVERSE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6131
Practice Address - Country:US
Practice Address - Phone:910-392-5634
Practice Address - Fax:910-392-5654
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001001833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant