Healthcare Provider Details

I. General information

NPI: 1174702047
Provider Name (Legal Business Name): LESLIE ANN BREEN ADULT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902-3068
US

IV. Provider business mailing address

37 FRIEND ST
LYNN MA
01902-3068
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6608
  • Fax:
Mailing address:
  • Phone: 781-715-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number146965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: