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General NPI Number Information
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NPI Number | 1912557372
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Entity Type | Individual
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Provider Name | BREANNA LEIGH DOENITZ ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 301 OLD MARLTON PIKE WEST SUITE 1
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City | MARLTON
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State | NJ
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Zip | 08053
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Country | US
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Telephone | 856-988-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 401 ROUTE 73 N STE 320
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City | MARLTON
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State | NJ
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Zip | 08053-3426
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Country | US
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Telephone | 856-988-9101
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | TMP-158957
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 26NJ01231600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 140609
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License Number State | KS
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