Provider Demographics
NPI:1700426442
Name:CHASE, BREANN MARIE (RN)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:MARIE
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2155
Mailing Address - Country:US
Mailing Address - Phone:909-773-8491
Mailing Address - Fax:
Practice Address - Street 1:1415 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2155
Practice Address - Country:US
Practice Address - Phone:909-773-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA842343163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health