Healthcare Provider Details

I. General information

NPI: 1184451189
Provider Name (Legal Business Name): BREAUNA HALFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 YORK RD
BALTIMORE MD
21212-2152
US

IV. Provider business mailing address

6401 YORK RD
BALTIMORE MD
21212-2152
US

V. Phone/Fax

Practice location:
  • Phone: 443-896-8225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR265258
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: