Healthcare Provider Details

I. General information

NPI: 1548197445
Provider Name (Legal Business Name): BREANNE LYN LIESKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 S REYNOLDS RD
TOLEDO OH
43615-7413
US

IV. Provider business mailing address

3556 MAXWELL RD
TOLEDO OH
43606-1921
US

V. Phone/Fax

Practice location:
  • Phone: 419-725-6290
  • Fax:
Mailing address:
  • Phone: 419-341-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: