Provider Demographics
NPI:1841537180
Name:BREHM, JEANNE ELIZABETH (LMT)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ELIZABETH
Last Name:BREHM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 CO HWY 3280
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439
Mailing Address - Country:US
Mailing Address - Phone:850-865-2065
Mailing Address - Fax:850-835-0101
Practice Address - Street 1:2516 CO HWY 3280
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439
Practice Address - Country:US
Practice Address - Phone:850-865-2065
Practice Address - Fax:850-835-0101
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32521171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3866OtherBLUE CROSS BLUE SHEILD