Healthcare Provider Details

I. General information

NPI: 1780904862
Provider Name (Legal Business Name): SUZANNE BREIT-PEREZ GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE MARIE BRIET

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 CR 309
LEXINGTON TX
78947-9607
US

IV. Provider business mailing address

4699 CR 309
LEXINGTON TX
78947-9607
US

V. Phone/Fax

Practice location:
  • Phone: 512-891-0056
  • Fax: 512-891-0075
Mailing address:
  • Phone: 512-657-5387
  • Fax: 512-273-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number672389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: