MEDICARE: NEW BREATH PNCC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1376115915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BREATH PNCC

Provider Business Mailing Address
First Line	:	4843A N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3826
Country	:	US
Telephone Number	:	414-364-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	4843A N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3826
Country	:	US
Telephone Number	:	414-364-8582
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DABRITTA HUBBERT
Credential	:
Telephone Number	:	414-364-8582

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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