Healthcare Provider Details

I. General information

NPI: 1700468329
Provider Name (Legal Business Name): BRITTANY BRETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RAVEN DR
CLOVIS NM
88101-2510
US

IV. Provider business mailing address

105 RAVEN DR
CLOVIS NM
88101-2510
US

V. Phone/Fax

Practice location:
  • Phone: 575-693-0709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-0366
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: