Provider Demographics
NPI:1245892710
Name:BRETON, JILL ANNE (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:BRETON
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 SWEET GUM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-6200
Mailing Address - Country:US
Mailing Address - Phone:252-665-1823
Mailing Address - Fax:
Practice Address - Street 1:360 COUNTY COMPLEX RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4846
Practice Address - Country:US
Practice Address - Phone:910-592-1131
Practice Address - Fax:910-592-4724
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011960363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health