Healthcare Provider Details

I. General information

NPI: 1902104326
Provider Name (Legal Business Name): BRIANNE M. SABLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNE M. BRECKHEIMER PA

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MAPLE LANE, SUITE 1
ASHLAND WI
54806-3610
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5794
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-7500
  • Fax:
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2721
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: