Provider Demographics
NPI:1336180306
Name:BREEN, PATTI (PNP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:BREEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1265
Mailing Address - Country:US
Mailing Address - Phone:612-362-4111
Mailing Address - Fax:612-362-4115
Practice Address - Street 1:342 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1265
Practice Address - Country:US
Practice Address - Phone:612-362-4111
Practice Address - Fax:612-362-4115
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-073625-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN852018600Medicaid
MN852018600Medicaid
MNS48223Medicare UPIN