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General NPI Number Information
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NPI Number | 1366003899
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Entity Type | Individual
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Provider Name | BREANNE HABERMAN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 3903 FAIR RIDGE DR STE 218
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City | FAIRFAX
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State | VA
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Zip | 22033-2945
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Country | US
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Telephone | 703-870-3750
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Fax | 855-749-9998
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Provider Business Mailing Address
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Address Line | 2305 N VAN BUREN CT
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City | ARLINGTON
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State | VA
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Zip | 22205-1941
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Country | US
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Telephone | 509-899-1693
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Fax | 855-749-9998
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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 | AP60919257
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024192364
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License Number State | VA
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