Healthcare Provider Details

I. General information

NPI: 1457932840
Provider Name (Legal Business Name): BREANNA NICOLE ALDRED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 W LOOMIS RD STE 310
GREENFIELD WI
53220-4858
US

IV. Provider business mailing address

4600 W LOOMIS RD STE 310
GREENFIELD WI
53220-4858
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-0424
  • Fax: 414-281-0959
Mailing address:
  • Phone: 414-281-0424
  • Fax: 414-281-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number82755-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: