MEDICARE: BREANNE LYN LIESKE

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	APRN.CNP.0042125	OH

General Provider Information

NPI Number	:	1548197445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNE LYN LIESKE

Provider Business Mailing Address
First Line	:	3556 MAXWELL RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1921
Country	:	US
Telephone Number	:	419-341-0952
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7413
Country	:	US
Telephone Number	:	419-725-6290
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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