Provider Demographics
NPI:1932785987
Name:PFEIFFER, BREYONNA FAITH
Entity Type:Individual
Prefix:
First Name:BREYONNA
Middle Name:FAITH
Last Name:PFEIFFER
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 1:854 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1841
Mailing Address - Country:US
Mailing Address - Phone:440-787-9501
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1841
Practice Address - Country:US
Practice Address - Phone:440-787-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUJ887937376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty