Provider Demographics
NPI:1265260178
Name:BIEVENUE, BREANNA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:BIEVENUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 STEPHANIE ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-5520
Mailing Address - Country:US
Mailing Address - Phone:618-521-4094
Mailing Address - Fax:
Practice Address - Street 1:17 1ST ST E
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TN
Practice Address - Zip Code:38069-4426
Practice Address - Country:US
Practice Address - Phone:731-548-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily