Provider Demographics
NPI:1902252612
Name:DUNCAN, BREANNA MARIE (BSN, RN, IBCLC, RLC)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:MARIE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OLD DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-4809
Mailing Address - Country:US
Mailing Address - Phone:678-231-8741
Mailing Address - Fax:
Practice Address - Street 1:1001 OLD DALLAS RD
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-4809
Practice Address - Country:US
Practice Address - Phone:678-231-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA214203163WL0100X
GAL-56497163WL0100X
TX893213163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant