Provider Demographics
NPI:1265280390
Name:LANDIS, BREANNA DAWNE (LPN)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:DAWNE
Last Name:LANDIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3337
Mailing Address - Country:US
Mailing Address - Phone:415-272-7810
Mailing Address - Fax:
Practice Address - Street 1:637 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3337
Practice Address - Country:US
Practice Address - Phone:415-272-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN321448164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse