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General NPI Number Information
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NPI Number | 1083482178
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Entity Type | Individual
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Provider Name | BREANNA FAYE MONDAY NP
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 2702 NAVARRE AVE STE 310
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City | OREGON
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State | OH
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Zip | 43616-3224
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Country | US
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Telephone | 419-725-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 4235 SECOR RD
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City | TOLEDO
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State | OH
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Zip | 43623-4299
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Country | US
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Telephone | 419-376-8269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704342762NSA230SR
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0035037
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License Number State | OH
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