MEDICARE: MISS TONETTE L BRECKENRIDGE CNA

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	170100000X	Ph.D. Medical Genetics	51885	NE
2	376K00000X	Nurse's Aide	D112503	IA
3	376K00000X	Nurse's Aide		NE

General Provider Information

NPI Number	:	1467472936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TONETTE L BRECKENRIDGE CNA

Provider Business Mailing Address
First Line	:	2907 FORT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-1741
Country	:	US
Telephone Number	:	402-884-4753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 FORT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-1741
Country	:	US
Telephone Number	:	402-884-4753
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/11/2025

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