Provider Demographics
NPI:1992748396
Name:BREEDING, JOHN LANCE (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LANCE
Last Name:BREEDING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STRYKERS RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-9496
Mailing Address - Country:US
Mailing Address - Phone:706-951-8396
Mailing Address - Fax:
Practice Address - Street 1:400 STRYKERS RD
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-9496
Practice Address - Country:US
Practice Address - Phone:706-951-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174561367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK161159Medicare PIN
CO804984Medicare ID - Type Unspecified
CO811675Medicare PIN