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General NPI Number Information
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NPI Number | 1285792598
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Entity Type | Individual
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Provider Name | MARTHA ANN BRECKENRIDGE NP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 423 W WHEATLAND RD STE 103
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4630
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Country | US
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Telephone | 469-567-1234
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Fax | 972-709-4600
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Provider Business Mailing Address
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Address Line | PO BOX 346
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City | DESOTO
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State | TX
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Zip | 75123-0346
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Country | US
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Telephone | 214-724-3723
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Fax | 972-709-4600
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 242859
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License Number State | TX
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