Provider Demographics
NPI:1952144040
Name:WARD, BREEANNA MICHELLE LEE
Entity type:Individual
Prefix:
First Name:BREEANNA
Middle Name:MICHELLE LEE
Last Name:WARD
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 1:2619 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4805
Mailing Address - Country:US
Mailing Address - Phone:740-353-0636
Mailing Address - Fax:
Practice Address - Street 1:2619 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4805
Practice Address - Country:US
Practice Address - Phone:740-353-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide