Provider Demographics
NPI:1487772125
Name:BREED, MARGARET JOYCE (LPN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:JOYCE
Last Name:BREED
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28505 SE ONE OAK LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97022-9665
Mailing Address - Country:US
Mailing Address - Phone:503-630-6745
Mailing Address - Fax:
Practice Address - Street 1:2330 NE SISKIYOU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2471
Practice Address - Country:US
Practice Address - Phone:503-528-0757
Practice Address - Fax:503-528-0764
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator