Healthcare Provider Details

I. General information

NPI: 1396586004
Provider Name (Legal Business Name): BREANNA NEIGHBORS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SURREY CRES
NORFOLK VA
23508-1130
US

IV. Provider business mailing address

1301 SURREY CRES
NORFOLK VA
23508-1130
US

V. Phone/Fax

Practice location:
  • Phone: 678-294-5506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9480473
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-309571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: