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General NPI Number Information
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NPI Number | 1376226969
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH INTEGRATIVE CARE LLC
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 9712 BELAIR RD STE 301
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1113
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Country | US
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Telephone | 443-903-4874
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Fax | 667-868-0931
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Provider Business Mailing Address
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Address Line | 9712 BELAIR RD STE 301
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1113
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Country | US
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Telephone | 443-903-4874
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Fax | 667-868-0931
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | BRIAN DYNELL WEST-PEARSON
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Credential |
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Telephone | 443-902-1364
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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