Active NPI
Breann Phaneuf
- Behavior Technician
- Alger, MI
National Provider Identifier
1073044665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- P510098777694
- Practice address
- 1078 Northern TRL
Alger, MI 48610-9337 - Phone
- (989) 942-2961
- NPI assigned
- Mar 24, 2017
- Last updated
- Mar 24, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | P510098777694 | MI | Primary |
Addresses
Primary practice location
1078 Northern TRL
Alger, MI 48610-9337
Mailing address
1078 Northern TRL
Alger, MI 48610-9337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P510098777694 | MI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490313600000",
"number": "1073044665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1078 NORTHERN TRL",
"city": "ALGER",
"state": "MI",
"postal_code": "486109337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1078 NORTHERN TRL",
"city": "ALGER",
"state": "MI",
"postal_code": "486109337",
"telephone_number": "989-942-2961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHANEUF",
"first_name": "BREANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-24",
"last_updated": "2017-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": "P510098777694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alger, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.