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General NPI Number Information
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NPI Number | 1871152330
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Entity Type | Individual
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Provider Name | BREANNA M GLYNN DO
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 149 NORTH ST
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City | WATERVILLE
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State | ME
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Zip | 04901-4974
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Country | US
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Telephone | 207-861-5101
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Fax | 207-872-4341
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Provider Business Mailing Address
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Address Line | 149 NORTH ST
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City | WATERVILLE
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State | ME
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Zip | 04901-4974
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Country | US
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Telephone | 207-861-5101
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Fax | 207-872-4341
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DO3354
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | DO3354
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO3354
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License Number State | ME
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