Healthcare Provider Details

I. General information

NPI: 1407344351
Provider Name (Legal Business Name): BREANNE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 SEAMAN ST
TOLEDO OH
43605-1519
US

IV. Provider business mailing address

2411 SEAMAN ST
TOLEDO OH
43605-1519
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-1520
  • Fax:
Mailing address:
  • Phone: 419-693-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: