Healthcare Provider Details

I. General information

NPI: 1750386330
Provider Name (Legal Business Name): LAURIE ANN BREBRICK MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE NEE DLUGI MSN

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 MISSION AVE STE 1
OCEANSIDE CA
92058-1354
US

IV. Provider business mailing address

3220 MISSION AVE STE 1
OCEANSIDE CA
92058-1354
US

V. Phone/Fax

Practice location:
  • Phone: 760-433-3155
  • Fax: 760-722-7359
Mailing address:
  • Phone: 760-433-3155
  • Fax: 760-722-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number953
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112396
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: