Healthcare Provider Details

I. General information

NPI: 1891521084
Provider Name (Legal Business Name): BREANNA CHILTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WOODHAVEN CT
SPRINGFIELD OH
45503-6247
US

IV. Provider business mailing address

1141 WOODHAVEN CT
SPRINGFIELD OH
45503-6247
US

V. Phone/Fax

Practice location:
  • Phone: 937-926-6507
  • Fax:
Mailing address:
  • Phone: 937-926-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.525993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: