Breanna Carlos
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Pocatello, ID
NPI 1124504337 · NPPES record last updated Jul 11, 2018
Key facts
- NPI
- 1124504337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1169 Call Creek Dr
Pocatello, ID 83201-3077 - Phone
- (202) 232-7780
- NPI assigned
- Jul 11, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1169 Call Creek Dr
Pocatello, ID 83201-3077
Mailing address
1169 Call Creek Dr
Pocatello, ID 83201-3077
Phone (208) 232-7780
Other providers in Pocatello, ID
- Care Creek Dental LLC
- Care LLC
- Care Planning Institute, Inc
- Carl B. Holm, D.D.S., P.C.
- Brady Carlen
- Janie Carlson
- Joel Andrew Carlson
- Saunja Carlson
- Emilia Marie Carrillo
- Taylor Carson
All providers in Pocatello, ID · Student in an Organized Health Care Education/Training Program in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.