Provider Demographics
NPI:1922400191
Name:BRECKUR, MARY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRECKUR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4602
Mailing Address - Country:US
Mailing Address - Phone:814-454-8185
Mailing Address - Fax:814-454-3894
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-454-8185
Practice Address - Fax:814-454-3894
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily