Provider Demographics
NPI:1083431803
Name:ORTIZ, BREANNA NICOLE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICOLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:NICOLE
Other - Last Name:VIRAMONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 CRESTWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6144
Mailing Address - Country:US
Mailing Address - Phone:562-631-7161
Mailing Address - Fax:
Practice Address - Street 1:2234 CRESTWOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-6144
Practice Address - Country:US
Practice Address - Phone:562-631-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC328959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse