Healthcare Provider Details

I. General information

NPI: 1538087200
Provider Name (Legal Business Name): BREANNA MARIE FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 E COVINA ST
MESA AZ
85205-9322
US

IV. Provider business mailing address

4166 E COVINA ST
MESA AZ
85205-9322
US

V. Phone/Fax

Practice location:
  • Phone: 951-575-5396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253545
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: