Active NPI
Breauna Latrice Dent, CNA
- Nurse's Aide
- East Saint Louis, IL
National Provider Identifier
1639930670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 147827
- Practice address
- 837 N 73Rd St
East Saint Louis, IL 62203-1713 - Phone
- (618) 514-2064
- NPI assigned
- Jan 17, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 147827 | MO | Primary |
Addresses
Primary practice location
837 N 73Rd St
East Saint Louis, IL 62203-1713
Mailing address
837 N 73Rd St
East Saint Louis, IL 62203-1713
Phone (618) 514-2064
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 |
|---|---|---|---|
| 147827 | MO | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1639930670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "837 N 73RD ST",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622031713",
"telephone_number": "618-514-2064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "837 N 73RD ST",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622031713",
"telephone_number": "618-514-2064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENT",
"first_name": "BREAUNA",
"middle_name": "LATRICE",
"credential": "CNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-17",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "MO",
"license": "147827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Saint Louis, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.