Provider Demographics
NPI:1922414838
Name:SKROCH, BREANNA (RN)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:SKROCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15459 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367-9717
Mailing Address - Country:US
Mailing Address - Phone:320-309-5173
Mailing Address - Fax:
Practice Address - Street 1:15459 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:RICE
Practice Address - State:MN
Practice Address - Zip Code:56367-9717
Practice Address - Country:US
Practice Address - Phone:320-309-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2154572163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health