Provider Demographics
NPI:1316787401
Name:BREITENBECK, NANCY LYN (RN, PI)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYN
Last Name:BREITENBECK
Suffix:
Gender:F
Credentials:RN, PI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 KILMER LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1632
Mailing Address - Country:US
Mailing Address - Phone:317-796-0679
Mailing Address - Fax:
Practice Address - Street 1:6505 E 82ND ST STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1543
Practice Address - Country:US
Practice Address - Phone:317-796-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28076665A1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study