Provider Demographics
NPI:1366003899
Name:HABERMAN, BREANNE
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:HABERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2305 N VAN BUREN CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1941
Mailing Address - Country:US
Mailing Address - Phone:509-899-1693
Mailing Address - Fax:855-749-9998
Practice Address - Street 1:3903 FAIR RIDGE DR STE 218
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2945
Practice Address - Country:US
Practice Address - Phone:703-870-3750
Practice Address - Fax:855-749-9998
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60919257363L00000X
VA0024192364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60919257OtherSTATE OF WASHINGTON - LICENSE
VA0024192364OtherSTATE OF VIRGINIA-LICENSE