Provider Demographics
NPI:1912557372
Name:DOENITZ, BREANNA LEIGH (ARNP)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:DOENITZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:LEIGH
Other - Last Name:ROUNDTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:856-988-9101
Mailing Address - Fax:
Practice Address - Street 1:301 OLD MARLTON PIKE WEST SUITE 1
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-988-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS140609163W00000X
KSTMP-158957363LP0200X
NJ26NJ01231600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse