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Individual
BREYANNA L OTLEWSKI
Active
Individual
BREYANNA L OTLEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003924A
IN
363A00000X
Physician Assistant
5601010349
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010888
MEDICARE
IN
05
—
300072508
—
IN
Enumeration date
02/22/2021
Last updated
04/05/2023
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