# BREAKAWAY FUNCTIONAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780528307
- **Authorized official:** AUSTIN MILL NP (OWNER)
- **Authorized official phone:** (480) 262-0249

## Contact information

- **Practice address:** 319 S MANDAN ST, BISMARCK, ND 58504-5558
- **Practice address phone:** (480) 262-0249
- **Mailing address:** 1409 BAYVIEW CT, BISMARCK, ND 58504-7087
- **Mailing address phone:** (480) 262-0249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | — |
| 171400000X | Health & Wellness Coach | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/15/2026
- **Last updated:** 04/15/2026