Provider Demographics
NPI:1811348212
Name:BREEDLOVE, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:BREEDLOVE
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 1:2186 GRAND CONCOURSE
Mailing Address - Street 2:1G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2004
Mailing Address - Country:US
Mailing Address - Phone:347-755-8861
Mailing Address - Fax:
Practice Address - Street 1:2186 GRAND CONCOURSE
Practice Address - Street 2:1G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2004
Practice Address - Country:US
Practice Address - Phone:347-755-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292908164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse