Breanna Dolan, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2018038474 Issued in MO

Practice address

16111 Manchester Rd.
Suite 101
Ellisville, MO 63011

Phone

(636) 751-9440

NPI assigned

Dec 17, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Breanna Wheeler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medwin Primary Care L.L.C.

  • Internal Medicine Physician
  • Arnold, MO
  • NPI 1376552067
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1629549506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16111 MANCHESTER RD.",
            "address_2": "SUITE 101",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-751-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16111 MANCHESTER RD.",
            "address_2": "SUITE 101",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-751-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLAN",
        "first_name": "BREANNA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018038474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNA",
            "last_name": "WHEELER",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.