Provider Demographics
NPI: | 1891598587 |
---|---|
Name: | BREATHE RIGHT PULMONARY, LLC |
Entity type: | Organization |
Organization Name: | BREATHE RIGHT PULMONARY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DNP |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHANDRA VIVIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SORRELLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DNP |
Authorized Official - Phone: | 701-541-2144 |
Mailing Address - Street 1: | 15105 W ROOSEVELT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | GOODYEAR |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85338-2512 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 701-541-2144 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2910 N LITCHFIELD RD BLDG 12 |
Practice Address - Street 2: | 15105 W ROOSEVELT ST |
Practice Address - City: | GOODYEAR |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85395-8533 |
Practice Address - Country: | US |
Practice Address - Phone: | 701-541-2144 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-03-29 |
Last Update Date: | 2025-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Single Specialty |