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General NPI Number Information
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NPI Number | 1689895864
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Entity Type | Organization
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Legal Business Name | MARTHA A. BRECKENRIDGE
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 1505 SANDSTONE CT
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City | DESOTO
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State | TX
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Zip | 75115-7841
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Country | US
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Telephone | 214-724-3723
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Fax |
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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 | 469-567-1234
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Fax | 972-224-5403
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MARTHA ANN BRECKENRIDGE
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Credential | WHNP
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Telephone | 214-724-3723
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 242859
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License Number State | TX
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Taxonomy #4
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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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