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General NPI Number Information
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NPI Number | 1124612452
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Entity Type | Individual
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Provider Name | SHANTELLE NICOLLE BREEZE AGNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 203 POMONA DR
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City | GREENSBORO
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State | NC
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Zip | 27407-1619
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Country | US
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Telephone | 336-282-0132
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Fax |
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Provider Business Mailing Address
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Address Line | 203 POMONA DR
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City | GREENSBORO
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State | NC
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Zip | 27407-1619
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Country | US
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Telephone | 336-282-0132
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | BREE-0E05L
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 264125
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License Number State | NC
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