Healthcare Provider Details

I. General information

NPI: 1821988528
Provider Name (Legal Business Name): BREANNA LYNN KADISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 LUDINGTON ST
ESCANABA MI
49829-1300
US

IV. Provider business mailing address

701 S LINCOLN RD
ESCANABA MI
49829-1138
US

V. Phone/Fax

Practice location:
  • Phone: 906-280-2711
  • Fax:
Mailing address:
  • Phone: 906-786-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704344852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: