Healthcare Provider Details

I. General information

NPI: 1619860871
Provider Name (Legal Business Name): SAMUEL RYAN BREAUX RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

1221 MASSACHUSETTS AVE NW APT 301
WASHINGTON DC
20005-5305
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 202-787-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN500009566
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: