Breann Kay Dalzell, FNP- C
Individual provider Active NPI Nurse Practitioner · Traverse City, MI
NPI 1447096763 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1447096763
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 4704326493 (MI)
- Practice address
- 1105 Sixth St
Traverse City, MI 49684-2345 - Phone
- (231) 935-5000
- NPI assigned
- Jul 5, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704326493 | MI | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704326493 | MI | Yes |
Addresses
Primary practice location
1105 Sixth St
Traverse City, MI 49684-2345
Mailing address
1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5000
NPI Registry JSON
{
"created_epoch": "1720137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1447096763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842345",
"telephone_number": "231-935-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842345",
"telephone_number": "231-935-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALZELL",
"first_name": "BREANN",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "FNP- C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-05",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704326493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
- Anna Kellogg D'Angelo
- Mozelle Dabell
- Gerald Dailey II
- Hannah Lea Dailey
- Daniel Pilade Dall'Olmo
- Meghan Irene Damman
- Dance of Life Midwifery LLC
- Daniel C. Madion DDS, MD PLLC
- Jennifer L Daniel
- Lisa Anne Danto
All providers in Traverse City, MI · Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.