MEDICARE: LAURIE BRESEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95020138	CA

General Provider Information

NPI Number	:	1174004659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE BRESEE

Provider Business Mailing Address
First Line	:	4520 BUSINESS CENTER DRIVE
Second Line	:	SUITE 180
City	:	FAIRFIELD
State	:	CA
Zip	:	94534
Country	:	US
Telephone Number	:	707-646-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 BUSINESS CENTER DRIVE
Second Line	:	SUITE 180
City	:	FAIRFIELD
State	:	CA
Zip	:	94534
Country	:	US
Telephone Number	:	707-646-3555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	12/08/2025

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Directions to “ LAURIE BRESEE ” Practice Location

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