Individual
GLENDA CAROL BREAKFELL PETROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNPC
Contact information
Practice address
22070 HIGHWAY 59, ABITA SPRINGS, LA 70420
(985) 892-0879
(985) 875-2384
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN099641AP03834
LA
363LF0000X
Family Nurse Practitioner
RN099641
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07931777
—
MS
05
—
1128139
—
LA
01
—
P00239061
RR MEDICARE
—
Enumeration date
05/23/2005
Last updated
01/28/2008
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