Provider Demographics
NPI:1366797938
Name:OBER, BREANNA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:MARIE
Last Name:OBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BREANNA
Other - Middle Name:MARIE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-466-2445
Mailing Address - Fax:717-466-2447
Practice Address - Street 1:101 W AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9274
Practice Address - Country:US
Practice Address - Phone:717-466-2445
Practice Address - Fax:717-466-2447
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055548363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
246305KAGMedicare PIN