Provider Demographics
NPI:1912478199
Name:BREUNINGER, KATHLEEN CLAIRE (MSN, MPH, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CLAIRE
Last Name:BREUNINGER
Suffix:
Gender:F
Credentials:MSN, MPH, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:7610 CARROLL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6321
Mailing Address - Country:US
Mailing Address - Phone:301-891-6141
Mailing Address - Fax:
Practice Address - Street 1:7610 CARROLL AVE STE 400
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6321
Practice Address - Country:US
Practice Address - Phone:301-891-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1031538363LP0200X
MDR224137363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics