MEDICARE: SUE ELLEN BREESE ANP-BC

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	163W00000X	Registered Nurse	14-97852-042	KS
2	163W00000X	Registered Nurse	2001005022	MO
3	363LA2200X	Adult Health Nurse Practitioner	53-46184-042	KS
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2001005022	MO
5	363LA2200X	Adult Health Nurse Practitioner	2001005022	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679757116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ELLEN BREESE ANP-BC

Provider Business Mailing Address
First Line	:	5950 N OAK TRFY STE 104
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-268-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 N. OAK TRFY
Second Line	:	SUITE 104
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-268-8501
Fax Number	:	816-452-5700

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	04/19/2022

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1750462339 — RAJIHA K AL SALMAN DDS
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1265596530 — MS. ANDREA GIBBS WILSON LPC
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1235647850 — HORMOZDI D.D.S. DENTURE CLINIC, PC
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Directions to “ SUE ELLEN BREESE ANP-BC” Practice Location

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