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General NPI Number Information
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NPI Number | 1538745765
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Entity Type | Individual
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Provider Name | BREANNA LYNN COLORINA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 2333 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60618-3838
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Country | US
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Telephone | 773-506-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 2476 SEMINARY AVE
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City | DES PLAINES
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State | IL
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Zip | 60016-4844
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Country | US
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Telephone | 847-924-7086
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209022774
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License Number State | IL
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