| Doctor Name: | BREANNA M DETRICK |
| NPI Number: | 1427438829 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | COA.17379-NP |
| Business Practice Address: | 4879 Us Highway 68 S Community Health & Wellness Partners Of Logan County West Liberty, OH - 433579525 |
| Business Phone Number: | 9375991411 |
| Business Fax Number: | 9375994128 |
| Mailing Address: | 4879 Us Highway 68 S, Community Health & Wellness Partners Of Logan County WEST LIBERTY |
| State: | OH |
| Postal Code: | 433579525 |
| Phone Number: | 9375991411 |
| Fax Number: | 9375994128 |
| NPI Enumeration Date: | 06/02/2015 |
| NPI Last Update Date: | 07/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.17379-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |