Amanda Loraine Breault (NPI# 1518528710, PAC ID# 5597091587) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1518528710 |
| PAC ID by PECOS | 5597091587 |
| Professional Enrollment ID | I20190729003436 |
| Full Name | Amanda Loraine Breault |
| Organization Legal Name | NORTHRIDGE FAMILY PRACTICE LLC |
| Address |
3190 N Ridge Dr Hale MI 48739 |
| Phone Number | 9897286000 |
| Gender | F |
| Graduation Year | 2019 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 9830118702 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230100 | TAWAS ST JOSEPH HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 3190 N Ridge Dr, Hale, MI 48739 | 9897286000 | NORTHRIDGE FAMILY PRACTICE LLC |
| Organization Legal Name | NORTHRIDGE FAMILY PRACTICE LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Beth Alice Weaver | Nurse Practitioner | Northridge Family Practice LLC | 3190 N Ridge Dr, Hale, MI 48739 |
| Debra Kaye Provoast | Nurse Practitioner | Northridge Family Practice LLC | 3190 N Ridge Dr, Hale, MI 48739 |
| Street Address |
3190 N RIDGE DR |
| City | HALE |
| State | MI |
| Zip | 48739 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Beth Alice Weaver | Nurse Practitioner | Northridge Family Practice LLC | 3190 N Ridge Dr, Hale, MI 48739 |
| Debra Kaye Provoast | Nurse Practitioner | Northridge Family Practice LLC | 3190 N Ridge Dr, Hale, MI 48739 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shannon Kay Chrivia | Chiropractic | 3141 M, Suite 65, Hale, MI 48739-8512 | |
| Shannon M Michaud | Nurse Practitioner | Ascension St Joseph Hospital | 116 S Church St, Ascension St Joseph Hospital Hale M, Hale, MI 48739-9272 |
| City | HALE |
| Zip Code | 48739 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | HALE + NURSE PRACTITIONER |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.