Provider Demographics
NPI:1588300339
Name:MAUK, BREANNE MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:MARIE
Last Name:MAUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 E BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1575
Mailing Address - Country:US
Mailing Address - Phone:419-957-9349
Mailing Address - Fax:
Practice Address - Street 1:600 AVIATOR CT
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9473
Practice Address - Country:US
Practice Address - Phone:937-208-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily