Healthcare Provider Details

I. General information

NPI: 1245055714
Provider Name (Legal Business Name): BREANNA VANHOOSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 JOHNSON ST
BURLINGTON ND
58722
US

IV. Provider business mailing address

2109 JOHNSON ST
BURLINGTON ND
58722
US

V. Phone/Fax

Practice location:
  • Phone: 417-213-2893
  • Fax:
Mailing address:
  • Phone: 417-213-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR56081
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: