Provider Demographics
NPI:1154919736
Name:BREAKFIELD, DAGAN M III (CRNP)
Entity type:Individual
Prefix:
First Name:DAGAN
Middle Name:M
Last Name:BREAKFIELD
Suffix:III
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 SULLIVAN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-692-7492
Mailing Address - Fax:833-791-1682
Practice Address - Street 1:3825 SULLIVAN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-692-7492
Practice Address - Fax:833-791-1682
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01210174363LF0000X
ALMD33350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMD33350Medicaid