Healthcare Provider Details

I. General information

NPI: 1801784640
Provider Name (Legal Business Name): ABIGAIL BREESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 JEFFERSON AVE SE STE 100
GRAND RAPIDS MI
49503-6300
US

IV. Provider business mailing address

204 HIGHLAND DR
ROCKFORD MI
49341-1543
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax:
Mailing address:
  • Phone: 616-322-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704285376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: