Provider Demographics
NPI:1942208798
Name:BREESE, JESSICA R (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:BREESE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 S FLAMINGO WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3909
Mailing Address - Country:US
Mailing Address - Phone:303-757-2802
Mailing Address - Fax:
Practice Address - Street 1:1551 S FLAMINGO WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3909
Practice Address - Country:US
Practice Address - Phone:303-757-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO122261176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68982216Medicaid