Individual
BREANA KOUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 N PLUMER AVE, TUCSON, AZ 85719-5906
(520) 232-6700
Mailing address
102 N PLUMER AVE, TUCSON, AZ 85719-5906
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP049949
AZ
Other
Enumeration date
09/23/2014
Last updated
09/23/2014
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