Provider Demographics
NPI:1881218220
Name:BREEN FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:BREEN FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:801-648-7859
Mailing Address - Street 1:5991 S 3500 W STE 400
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-6702
Mailing Address - Country:US
Mailing Address - Phone:801-845-4911
Mailing Address - Fax:833-974-0917
Practice Address - Street 1:5991 S 3500 N
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067
Practice Address - Country:US
Practice Address - Phone:801-845-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty