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General NPI Number Information
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NPI Number | 1679386619
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Entity Type | Individual
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Provider Name | BREANNA CONNELLY APRN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2874 N CARSON ST STE 135
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City | CARSON CITY
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State | NV
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Zip | 89706-1681
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Country | US
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Telephone | 775-770-9445
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Fax |
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Provider Business Mailing Address
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Address Line | 6080 INGLESTON DR UNIT 1025
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City | SPARKS
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State | NV
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Zip | 89436-7085
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Country | US
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Telephone | 702-622-6837
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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 | 842180
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License Number State | NV
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