Healthcare Provider Details

I. General information

NPI: 1881130433
Provider Name (Legal Business Name): BREANNA ZIPFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 STATE ROUTE 108
WAUSEON OH
43567-8200
US

IV. Provider business mailing address

1777 S CLINTON ST APT 2
DEFIANCE OH
43512-3268
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-3732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: