Provider Demographics
NPI:1932271426
Name:BREITENEICHER, DARLENE E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:E
Last Name:BREITENEICHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:DARLENE
Other - Middle Name:E
Other - Last Name:HESKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12247 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5523
Practice Address - Country:US
Practice Address - Phone:301-434-8985
Practice Address - Fax:301-434-8067
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
012905K92Medicare ID - Type Unspecified
Q04268Medicare UPIN