MEDICARE: MRS. CAROLINA M BREED PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA61348669	WA

General Provider Information

NPI Number	:	1922772748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINA M BREED PA-C

Provider Business Mailing Address
First Line	:	18209 WA 410 E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391
Country	:	US
Telephone Number	:	253-951-5135
Fax Number	:

Provider Business Practice Location Address
First Line	:	18209 WA 410 E STE 303
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391
Country	:	US
Telephone Number	:	253-951-5135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	04/28/2026

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