Provider Demographics
NPI:1922766492
Name:TWILLEAGER, BREANNAH
Entity Type:Individual
Prefix:
First Name:BREANNAH
Middle Name:
Last Name:TWILLEAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S LINDEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3443
Mailing Address - Country:US
Mailing Address - Phone:810-732-8087
Mailing Address - Fax:
Practice Address - Street 1:3927 E PATRICK RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6501
Practice Address - Country:US
Practice Address - Phone:760-990-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703123610164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse