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Individual

KEITH J BREASURE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN,NP

Contact information

Practice address
130 FISHER RD, BERLIN, VT 05602-9516
(802) 371-4316
(802) 371-4579
Mailing address
PO BOX 547, ATT: CVMC FINANCE DEPT, BARRE, VT 05641-0547
(802) 371-4316
(802) 371-4579

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
LG0000383
DE
363LF0000X
Family Nurse Practitioner
Primary
101.0096152
VT

Other

Enumeration date
05/10/2006
Last updated
02/12/2015
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