Provider Demographics
NPI:1699174227
Name:ROCHE, BREANNE
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:ROCHE
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 1:7360 ROLLINGBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5158
Mailing Address - Country:US
Mailing Address - Phone:440-223-4782
Mailing Address - Fax:
Practice Address - Street 1:7360 ROLLINGBROOK TRL
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-5158
Practice Address - Country:US
Practice Address - Phone:440-223-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15894363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics