Healthcare Provider Details

I. General information

NPI: 1477332989
Provider Name (Legal Business Name): BREANA LYNN SPAIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HUGHES RD
MADISON AL
35758-2237
US

IV. Provider business mailing address

20 HUGHES RD
MADISON AL
35758-2237
US

V. Phone/Fax

Practice location:
  • Phone: 256-213-2229
  • Fax: 256-213-9978
Mailing address:
  • Phone: 256-213-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-153541
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: