Provider Demographics
NPI:1699118349
Name:KOLOWICH, BREEANNA
Entity type:Individual
Prefix:
First Name:BREEANNA
Middle Name:
Last Name:KOLOWICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-9471
Mailing Address - Country:US
Mailing Address - Phone:810-814-3114
Mailing Address - Fax:
Practice Address - Street 1:433 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-9471
Practice Address - Country:US
Practice Address - Phone:810-814-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other